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 always the objective and there are many things which physician practices can do to meet this objective, including always having the best and most modern technology, for instance.

Without making sure that their medical practice has the relevant technology, physicians will find it hard to move with the times. In the medical world, especially, it is more important than ever that modern technology has been implemented so they can diagnose and treat patients who need their help with significant ease. Of course, these technological advancements can come with their disadvantages, particularly if they have been left open to hackers. You will be violating many rules if medical records get into the wrong hands, so you need to make sure that you have full protection.

Having different technology can help to make sure that storing ultrasound images, and uploading them is a lot easier. As such, you can bill patients at a much faster rate. But there is a big issue which is holding some practices back. Complications in practice management come as a significant backdrop forcing businesses to lose out on 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. 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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