Are you completely frustrated with the process of prior authorization that is impeding your chances of providing quality patient care? It is true that delays in the prior authorization will steal your time as a physician. It will increase your practice costs.
It can stall your entire care management process and can pose some major roadblocks. The ideas should be to get in touch with experts in practice management that understands claims adjudication priorities of the payers.
While there is no simple roadmap ahead, some functional best practices will eventually help you stay early with your verification and authorization activities. Prior authorization costs are right now close to $32 billion in US healthcare. It is important to comply with the regulatory environment and how disclosures of pre-service information will be taking place.
The perfect process flow in Prior Authorization
Check the requirements before services and preventing delays with filing prescriptions and the denials of claims are mandatory.
♦ Lost payments eventually will be resulting from requirements in prior authorization and unmet prerequisites. A consistent capture management process is necessary that will help in quick eligibility verification and reducing time in first time PA requests.
♦ Establishing a consistent protocol and consistently documentation is a prime concern in the prior authorization process. It is important to follow a uniform approach that will help you avoid delays in the patient therapy process.
♦ You have to develop an actionable plan that will help you in preventing unnecessary follow-ups with the patients for additional information.
Minimize time in prior authorization requests will be a key asset. Robust processes and skilled resources expert in understanding claim adjudication mandates will be important.
How long should your Prior Authorization take?
Scenario planning and selecting the best option in a particular situation and the availability of the options is the need of the hour in the prior authorization. We all know that today there are a lot of options available including the standards electronically.
♦ There are portals with health plan; fax, as well as the telephone with email, is some of them. A toolkit from American Medical Association clearly explains the potential benefits and disadvantages of each method.
♦ Making educated decisions is important as a practice. Selecting the right alternative the suits your practice should be the strategic idea.
♦ Regular follow up and ensuring timely pre-approval is primarily a manual process. It is precisely why a lot of requests get lost in one of the several steps you take.
♦ Track your prior authorization requests and prevent delays that can often happen with insecure sharing of information. Rapid automation methods that make medical billing simpler will be a pertinent goal.
An appeal that is well articulated will help you counter inappropriate prior authorization and build a strong case with necessary clinical information. Re-submission of the required data that was overlooked in the initial request has to be concise and well organized. Think to adopt technology for a strong benchmark in medical billing that further streamlines and ensures checks and balances.