Patients often wait for permission before treatment, and this delay affects their care. It’s crucial to approve these permissions fast so patients get treatment and you get paid.
Good news! You can ease this burden by organizing your work better. Build relationships, be accurate, and stay focused. Here are 8 tips to speed up authorization approvals.
What Is Prior Authorization?
Checking ahead for permission speeds up billing and cuts down on denied claims. It’s smart to ask if you need permission before doing treatments not covered by insurance. Getting approval not only helps get claims paid but also makes billing easier.
Before patients start, check if they need permission. After checking their insurance, make sure permissions are needed. If it is, send the codes for the procedure and diagnosis to the insurance company. They’ll decide if they’ll allow it. Once approved, set up the procedure. However, medical billing companies in Massachusetts are the best choice when billing seems pretty much difficult for the healthcare providers. Also, following these steps avoids claim denials, delays, and rescheduled appointments.
Push Prior Authorization to abode Treatment Abandonment
Getting permission before a treatment is super important. It affects how healthy a patient stays. A survey found that most doctors wait for approval from the patient’s health plan. For some, it takes a day or more. This waiting makes it tough for patients to get care on time. In fact, most doctors say it leads to them stopping treatment or it affects how well the patient gets better.
Maximize your practice Management (PMS) And Electronic Medical Records System
You spend a lot on PMS/EMR systems, so make them work well! Talk to your PMS/EMR providers to create reports for managing and improving your authorization process. Use these reports to make error-free workflows. They should show when you need authorizations and when you get them. Also, use other resources your PMS/EMR provider offers, like groups and meetings.
Groups help you meet others with different solutions. Conferences let you tell your providers what you need. If they don’t give you the reports you need, tell them. Others might need them too.
Teach Doctors About Document Rules for Approval
Doctors need to learn about getting permission for patients. They should know the patient’s insurance and who to talk to if the treatment changes. Also, they must know all the steps because their records are crucial.
Explain how trying simpler treatments is necessary. Insurance usually wants proof that these treatments didn’t work before allowing riskier ones. Share your issues with doctors and tell them what you need. If they don’t listen, show them the money they’re missing. Numbers often convince better than words!
Be accurate with the exact information
Making mistakes during patient intake causes problems with getting prior authorization. So, it’s super important to get all the info right. Make sure names and addresses match exactly how they’re in your systems.
Some systems copy patient info from somewhere else. Teach your intake team everything about the payers to avoid issues.
If the patient isn’t the subscriber, missing subscriber info slows things down. Also, find the correct payer address. Some have many addresses across states. Knowing where to go is crucial for getting prior authorization without wasting time.
Work On Your Denials And Flag Prior Authorizations s
Getting denied can be tough, but it’s a chance to learn. By understanding why it happened, you can prevent it next time. Your system should have reports that show why the denial happened.
Check these reports to see what went wrong and if there’s a trend. Then, team up with your software provider to fix it. You could make reports that highlight when specific payers and procedures need approval ahead of time, helping your team be prepared
Fix The Denials
Fixing denials is a hassle, but it’s a chance to learn. Figuring out why they happen helps stop them next time. Your system should give reports about denials so you know why they happened.
Check these reports for patterns. Then, team up with your software provider to make your system smarter. Make reports that highlight when certain payers and procedures need approval beforehand. This helps your team prepare.
Understand Payer Policies and Stay Updated
Each payer has its own rules, and most of them share these rules online. You should learn and follow these rules, keep an eye on any changes, and save older versions. If a payer argues about a 2018 issue, they should use the 2018 rules, but sometimes they’re not updated about which rules are in question.
That’s why it’s vital for you to stay well-informed. It’s also smart to keep records of newsletters, emails, and any info from payers about their current rules.
Partner with the third party medical billing companies
Outsourcing prior authorization can streamline the process by tapping into specialized expertise. It ensures a dedicated team handles the complexities, reducing errors and improving efficiency. This approach frees up in-house staff to focus on core tasks, preventing backlogs and minimizing delays.
Moreover, outsourcing to medical billing services often leverages established relationships with payers, enhancing approval rates and decreasing denials due to a better understanding of payer requirements. Overall, this strategy optimizes workflow, expedites approvals, and boosts revenue by mitigating issues such as administrative burdens, errors, and delays in the prior authorization process.
Build Good Relationships with Your Insurance Reps
Your provider rep links your practice to the insurance company. They help with coverage, benefits, and keeping a positive connection. Use this connection wisely. Get friendly with your rep. Share your issues, especially about getting authorization.
Ask them to visit your clinic, meet your doctor, and see your place. This bond helps solve patient problems. Even though insurers think authorization is crucial for the right treatment, dealing with it can still be a hassle for you.
Get Faster at Approving Requests
Join Gina Piccalilli, an expert in preauthorization, for an online training on Wednesday, January 15th at 1pm ET. Gina’s session will teach you everything about speeding up your preauthorization process to get more money back. Here’s what you’ll learn in this 60-minute training:
- Approve medicine & test requests quicker without wasting time on calls
- Learn a 3-step method to reverse rejected approvals
- Ensure no more missed authorizations and payments
- Reduce claim denials for necessary treatments and get paid more
- Plus, a lot more!