Secrets to Streamline Your Prior Authorization Process
Accurate prior authorization is a vital function in healthcare revenue cycle management. Not only that, but it is one of the most complicated processes in RCM.
One of the major challenges in this realm is the high volume of prior-auth requests. It has been identified that each provider works roughly on 41 prior-auth requests weekly. And the process being extremely time-consuming is making matters worse.
In recent years, the healthcare industry has made some inroads to improve pre-authorization processes. However, a lack of standardization is posing a threat to the effective execution of the same.
4 Tips to Improve Prior-Authorization
A prior auth professional must ensure 100% authorization submission on the same day and work on faster prior auth approval. In fact, below are a few strategies to check your prior auth request and its approval.
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Gather accurate patient information:
Obtaining comprehensive and accurate patient information is paramount in prior authorization. Collect and verify the patient’s demographic information, medical history and insurance coverage details. Also, ensure that all necessary documents, such as clinical notes, treatment plans, test results are readily available. As a result, you will have a faster PA process and increased chances of claim approval.
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Understand insurance policies and guidelines:
You need to have a deep understanding of insurance policies and guidelines to navigate the PA process successfully. Furthermore, you need to stay updated about the changes within different insurance policies.
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Leverage technology and automation:
The 2021 report of Council of Affordable Healthcare Index shows only 26% of PA was electronic. On the contrary, the 2023 report shows that technology integration within the process has reduced errors, staff shortages and security challenges. Hence, it is evident that embracing technology and automation within pre-auth can streamline the overall process and optimize the revenue.
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Robust tracking system and follow-up:
Maintaining a robust and centralized tracking system can be effective in accurate prior-auth. You can create a centralized database or use specialized software system to track the status of the authorization requests. Also, you can consider necessary follow-ups through the same to optimize the process.
Outsource Your Prior Authorization Process
Prior authorization is undoubtedly an intricate process. It is time-consuming and prone to delays. Staff shortage and increasing labor costs are increasing the complexity for the providers as well.
In this scenario, you can consider outsourcing of PA. A genuine medical billing and coding partner can optimize your PA while reducing errors, enhance reimbursements and improve overall operational efficiency.
Outsourcing your pre-authorization helps you to focus on patient care, while the partner works as an extended operational arm. Furthermore, a team of experts is always updated about comprehensive regulations and guidelines that help you maintain compliance within the process.
Over the last few decades, Sunknowledge Services Inc, has been offering niche assistance at next-door rates to the best one in the industry. With great consistency and the highest productivity metrics, the team transforms your ROI needs.
You can engage in a discussion over a call with the Sunknowledge experts. You can opt for this team of dedicated employees who will provide you with tailored services and optimized operations.
