According to an American Medical Association poll performed in 2017, 84 percent of survey participants assessed the burden of prior permission on physicians and personnel as high or extremely high. According to other research, doctors spend an average of 20 hours per week and over $83,000 per year engaging with insurance companies. These figures will continue to grow as the incidence of prior authorization requirements rises.
Prior authorization begins with physicians long before the procedures of RCM services. It is a difficult process that takes up a significant amount of physicians’ productive time, which might be better spent on providing better patient care.
However, unless there is significant prior authorization change in the healthcare sector, providers must continue to obey the criteria established by payers. Here are six measures that provider organizations may take right now to simplify the prior approval process.
Understand what is necessary. Check the authorization requirements before providing treatment, especially for procedural and surgical procedures. Examine and use available payer coverage determination criteria and/or medical policy guidelines to proactively submit required information on the first try.
Make the most of your resources. Create and use EHR clinical templates tailored to individual payers and procedures to ensure proper capture of the clinical documentation requirements required for approval.
Reduce the number of steps in your procedures. Direct your initial efforts on the top 10 to 15 payers. Create informational summaries for each (particular requirements, preferred method of contact, etc.) that are easily available to staff. Track your prior authorization filing and associated results with a simple spreadsheet.
Play it smartly. Prior authorization requests and accompanying documents must be submitted in the proper format. only provide what is necessary. Establish clear policies, time frames, and processes for follow-up. Create and keep standard letters of appeal on hand for use in the case of a refusal.
Examine and evaluate prior authorization monitoring data by payer to have a better understanding of what types of care are at risk of refusal. Determine any disparities in staff approval rates.
Implement operational improvements that focus on best practices for successful submissions. By following these industry standards, health systems may improve the speed of the prior authorization process while reducing the strain on clinicians and staff. These measures help decrease the risk of patient care delays, operational roadblocks, and rejections.
In the RCM business, there are several efficient methods for improving prior authorization. Regular monitoring of operations, and medical equipment that require prior authorization, as well as implementation of the most recent technical standards for PA, will aid in optimizing pre- authorization.
WWS has extensive access to cutting-edge tactics for establishing and documenting your prior authorizations. Our skilled staff will manage your whole payroll process and assist you in meeting your company objectives.