Since January, nearly a dozen states have passed laws for which state medical societies aim to cut the growing volume of prior authorizations requirements, reduce patient care delays and improve transparency within the processes.
However, providers across the country are still struggling with the high prior authorization denial rates, considering the ever-evolving environment of the industry.
A survey by the American Medical Association has found that providers on average complete 41 prior authorizations s each week and spend almost two-business days in a week by working on the process.
Most of the providers have admitted that it creates an extra administrative burden as the changes in payor prior authorizations requirements, and expansion on the types of visits requiring preauthorization, leading to upswing in PA denials.
Root Causes of Prior Authorization Denials
You might be getting enrolled with new insurers as your practice grows and every insurance carrier has its own prior authorization submission requirements. It is evident to receive denials on authorization with every new payor.
Even if you are constantly working with a few selected insurers, there are still chances of errors. The main reason behind this is insurers often change their prior authorizations submission requirements, and while you are busy providing care, it is difficult to stay updated with that information.
Another obvious reason is skilled manpower shortage. You need skilled manpower to identify and understand the prior authorizations requirements, timely submission of the documents supporting your application, and of course consistent follow-up.
The current competitive market, increasing inflation, changing patient care approach and stratospheric wages make it difficult for the providers to maintain an in-house administrative staff.
Best Practices to Enhance Prior Authorization Services
Some precautionary measures can mitigate the prior authorization denial risks. Here we have listed the strategies through which you can improve your authorization process.
1) Insurance eligibility verification:
Ensure that every time you verify patient’s insurance eligibility and benefits related to the required services. Scrutinize the services that require prior authorizations and what are the documentation requirements for the same.
2) Accurate codes:
It is crucial that if you have a billing team you work hand-in-hand to mitigate the chances of errors in coding. If your staff does not understand procedural codes and their implementation there will be more errors which will further lead to denials.
For instance, if you schedule a biopsy that does not require authorization, but within the same an excision of a lesion is performed which requires authorization, the claim for excision will be denied.
3) Outsourcing:
Partnering with a prior authorization company who has a team of experts can be a plausible solution for you. A team of dedicated medical billers and coders can transform your practice’s performance and induce growth with their knowledge, technology and industry comprehensive practices.
Conclusion
The most important thing in managing prior authorization denials is to be never afraid to appeal a payor’s decision. Consistent follow-up and monitoring the status of authorization can significantly reduce prior authorizations denials in your practice.
Or you can simply outsource your pre-authorization services from Sunknowledge Services Inc.
On an average a practice sends out 100s of prior authorizations requests within a month. However, most of them get denied due to lack of time and specialty-wise expertise in your team.
Well, a prior authorizations expert like Sunknowledge can work as per your practice requirements and preferred time zone, which makes them an operational extension of your practice.
To learn more about their services, you can connect with one of the experts over a non-commitment call today!
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