- October 6, 2022
- Posted by: spiderman
- Category: Prior Authorization
Pursuing Better Success with Prior Authorization
Prior Authorization for healthcare services, as mandated by insurance companies, is a much-debated topic. While it is useful for curbing overspending and for ensuring better safety for patients from possible adverse side-effects that may arise from drug combinations, prior authorization is also notorious for delaying caring and leading to unfavorable patient outcomes. While efforts are underway to shorten the time that a prior authorization request usually takes (which can be anywhere between 5 to 10 days, depending on the payer) by encouraging e-authorization standards across the board, a full-scale implementation will take time. Till this happens, one of the most effective ways to make sure that prior auth requests do not delay patient care any longer than what is absolutely necessary, is to focus on improving their first-pass rate.
Whenever a prior auth request is submitted, it can either get approved, or denied, or get asked to be resubmitted with additional information, or returned with suggestions for a less expensive alternative. In cases where a request is returned for the lack of adequate information, or sufficient proof of medical necessity, resubmitting the request only lengthens an already long process. This, however, can be avoided with an early intervention by the prescribing physician. Supporting documentation that should typically accompany a Prior Authorization request, usually originates from the physician’s office. The process should be started early, with the concerned physician ensuring that all required documentation, duly signed by him, have been generated and collected, ready to be attached to the prospective PA request. This makes the following steps easier and quicker for the billing personnel.
Further Help with Prior Authorization
It is evident that success with Prior Authorizations comes from an efficient and organized approach to the task. Unfortunately, this is one area where many providers find themselves lacking. Inadequate or unskilled staff, lack of a proactive and dedicated approach, not following up on submitted requests diligently – these are but just a few of the practical problems faced by healthcare providers.
This is why many practices enlist dedicated, professional help from specialized third-party billing support providers. Through strategic outsourcing of Prior Authorization tasks to billing experts, providers can easily introduce better efficiency in their revenue generation process. Professional intervention can help bring down denial rates, increase approvals and get more PA requests completed in a day than before. This last advantage is something that busy practices can benefit from tremendously.