Tips to Better Prior Authorization of a Medical Practice

Losing on productivity is one of major challenges for any physician practice. Providing better medical care is the objective! But complications in practice management come as a significant backdrop forcing businesses lose out in billions.

To reduce the gap between claims & payables, prior authorization is a critical benchmark that has to be ensured at the onset. A medical practice will need to employ better checks that will facilitate quality denial management.

It is one of the expensive deals that a provider encounters every year in US healthcare! The AMA studies way back has proved that with more than 835,000 physician practices, approximately 868.4 million hours are engaged with preauthorization.

Annually, prior authorization services cost more than $69 billion to practices. Claims adjudication guidelines are complex, and 70% first time PA requests are denied every year. Billing costs increase creating enough pain areas for a practice to manage revenue cycle.

Payer’s idea with prior authorization of a medical practice is simple! They need better handling of patient safety by acting as the advocate. The enormous amount of time and money yield lesser results with care management solutions getting undermined.

Addressing the problem area isn’t a simple task! Providers will have to make possible changes that will reduce their turnaround time with claims submission and payments. Getting prior approvals and a complete benefits check will be able to hold down on billing costs. Cost effective measures with innovative solutions is the road ahead for practices!

Using Technology Platforms

Disruptive technology, internet of things and enterprise mobility has changed the business world. Today, a practice needs to use elementary tools like the electronic health record (EHR). There has to be tailored alerts that will help a practice better their regular prior authorization process. Reducing time is the key and customized billing software will be an excellent idea!

Tracking the status of prior authorization requests and also showing the number that a practice will require for a particular time span (daily, monthly, yearly) should help immensely in streamlining the process.

Research on Payer Websites

A provider will have to invest significant amount of time understanding the credentialing and adjudication process of the payers. Websites today serve as a consistent source of information helping practices understand processes with PA submission requests.

Outsourcing of prior authorization services provides timely intervention. Today, a lot of vendors look to add value with their process excellence and an expert team in medical billing. Some of them have excellent references from leading providers.

They give the confidence to a practice helping them focus on their patients and reduce gap in procedures and prescriptions. Business relationship with TPA’s, MSO’s and constant interaction with insurance companies require specialized operations. The RCM companies add a business edge by serving value to a provider’s practice management strategy.

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