How to Reduce Preauthorization Denials

With all of its benefits, such as a significant reduction in unnecessary spending, prior authorizations still come with a lot of burdens, according to the 2018 AMA Survey. For instance, over 75% of respondents are burdened by the preauthorization process for patient treatment. Response wait time averages from one to three business days. The process can be extremely time-consuming, taking away valuable and limited resources from patient care. Unfortunately, this can cause patients to not only experience delay in their treatment, but also have their claims denied by insurance companies. Here are five ways to minimize negative impacts, resulting in time savings and payment.

1. Make Use of Substitutes

One way to reduce the burden of prior authorization without impacting patient care is to use substitutes for medications or procedures which do not require preauthorization. When such medications or procedures are used, it saves time and eliminates the risk of having insurance claims denied as a result of incorrect details or no approved authorizations.

2. Dedicate Personnel to the Preauthorization Process

Over one in three physicians have persons assigned to fulfilling and managing the preauthorization process. This ensures proper rules and processes are always applied. Dedicated personnel for this process can be as small as one person to a team.

3. Go Digital

While many Electronic Health Record (EHR) systems are equipped to submit electronic preauthorization requests, some are not. If you are in the market to upgrade your system, place this functionality as a must have.

4. Set Rules and Alerts

Further customize your EHR system to alert when medications or procedures require a preauthorization from the insurance carrier. Even if the document itself can not be submitted electronically from the system, at the very least you have a safeguard in place to ensure the necessary steps are taken to prevent a prior authorization denial. On top of this, especially for top volume of services used requiring an insurance carrier's approval, invest in the time to create a checklist of items required per carrier per procedure. Make certain the alerts are triggered throughout relevant departments so all parties from front to back have the information. Check if your system can be configured so that once the preauthorization is approved, the system will update. This will save time, streamline departments and prevent headaches down the road.

5. Keep Patients Informed

You've heard of surprise medical bills? So have your patients when they receive a bill for a treatment that should have been covered by their insurance. A denial will result from no preauthorization on file.

When there is a delay in patient treatment due to a preauthorization issue, ensure to train your team to keep patients in the know regarding the extra wait time they may experience.

Prior authorizations can be a very stressful and time-consuming process for all vested parties. Therefore, implementing the above tips can create a less burdensome process, better cash flow, and a happier patient experience.