7 Ways to Speed Up The Prior Authorization Process

Prior authorization, also known as preauthorization, can be more frustrating for a physician if it takes more than two days to more than a month and is ultimately denied. You know, a specific patient requires that specific prescription medicine, MRI tests, or treatments, but we have no control over that because the insurance company will decide whether or not to cover it.

According to a PLOS ONE survey, 60% of doctors believe 15–30% of medical treatment is unnecessary. Though the prior authorization process is intended to control costs and utilities, it can sometimes be detrimental to health and diminish a physician’s practice management.

So, before we get into the specifics of streamlining prior authorization, let’s look at the reasons for rejecting prior authorization applications.

  1. Prescribed drugs that aren’t mentioned in the compendium.
  2. PA Application Error in Administrative Coding
  3. The prescribed line of treatment may not be required.
  4. Medications that aren’t compulsory
  5. Medicines not authorized by FDA labels
  6. Evidence that is weak and ambiguous

The above list is a solid reason for the rejection of prior authorization.

Prior authorization must be streamlined to provide consistent patient care. So, to save time in this process, the methods listed below can ease the burden and help accelerate the approval.

1.  Acknowledge every requirement for the application to be authorized.

Each insurer has its own rules for approving a prior authorization request. Before submitting applications, a physician should take notes and understand the procedure. As a provider, you should try to avoid being rejected at all costs. Cross-check the certification and avoid procedural errors, which will undoubtedly speed up the process because it will make the payer’s evaluation easier.

  • Prepare clinical reports that are straightforward and brief.

The goal is to produce precise, complete paperwork that is up-to-date on the patients’ medications. Terminology and diagnoses can be challenging to understand for payers at times.

When the given prescriptions don’t adhere to the rules, including an explanation showing why the patients require those drugs. Simplify diagnostic reports so that they are apparent to the payer. Ambiguous documents are a significant reason for the approval process to take so long and for prior authorization requests to be denied.

3.  Prescribe a less expensive and simpler therapy plan.

A physician’s role in streamlining pre-approval procedures includes prescribing less expensive and more effective drugs and tests. One of the most common reasons for pre-approval denial is that insurers believe a less expensive treatment can replace the costly therapy.

The payer or insurance director may evaluate and find the given prescribed medication from the service provider is unnecessary, which can be achieved with one-time therapy rather than long-term medicines. As a result, a provider must ensure that the drugs prescribed are less expensive and that the cure is obtained quickly.

4.  Recruiting pre-auth specialists

Errors in documentation can halt the procedure. You can speed up the pre-auth process as a provider by hiring someone familiar with the rules and formalities that must be followed in submission. An in-house faculty member may take longer to process the application, whereas a specialist may complete a task in less time.

A regular employee on the job is more likely to make mistakes in documents than an expert who is well-versed in obtaining approval from the insurer. You can transfer your workload to the specialist and acquaint them with your medical practice management policies and procedures.

To speed up the process, provide them with the required software, such as medical billing software or a practice revenue calculator.

You can speed up the initial authorization processes by following these simple steps.

5.  Clear communication between provider and payer

“Communication is the key to success,” as the old proverb goes. The provider should be well-versed and confident in communicating every detail and learning why the application is rejected. Knowing the basis for one denial can help you avoid hundreds more. Communicate clearly with the payer and obtain a complete and accurate explanation. Because you may not always understand the reason for a delay or rejection, communicating the requirements and rules ahead of schedule will save you a lot of time.

6.  Include the recommendations of the patient’s company

Getting the patient involved is a powerful weapon for speeding up the process. A reference from higher officials or a patient’s company can quickly help the payer approve the claim because the insurance does not want to let down any officials who provide leads or lose this prospective lead from the company.

7.  Upgrade to take advantage of new technology

Prior authorization has become smoother and easier to approve in recent years. This could be due to the use of cutting-edge technology and software. The transition from manual to electronic evaluation has facilitated insurers’ work. Implementing new innovative methods and techniques has reduced workload and increased revenue in medical practices.

Medical billing software, for example, has significantly accelerated the process. However, we cannot ignore the most recent technology for calculating practice revenue to keep patient records up to date. Embracing technology helps hospitals develop their care and revenue departments.

A medical practice revenue calculator will help you avoid mistakes and quickly prepare patients’ billing records.

Conclusion

In the past, physicians got terrified by listening to the name of prior authorization processes. This is because it is a time-consuming and lengthy procedure in those days. Even after applying, it took a long time for the patient’s application to be approved. During this time, the process has been running smoothly and quickly.

There is no concern about not being approved unless the prescription is more expensive and less necessary, paperwork issues and ambiguous statements, or lack of communication. Everything may be the result of a failure to follow the rules. As a result, rejection reasons can be avoided even with the most advanced technologies. Technology and software are critical in accelerating the prior authorization procedure.

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