Insurance policies can change anytime, affecting medical billing and claims processing. To add more benefits, prior authorization requirements for procedures are frequently updated. They differ depending on the payor, making it even harder and more complicated to determine whether a given medical procedure needs prior authorization and to take it promptly to prevent claim denials and revenue loss. A planned strategy for prior authorization can assist in reducing related denials because minimizing claim denials is a crucial need for any practice.
Let’s examine how advanced authorization has been harming medical practice revenue and discuss a step-by-step strategic plan to address these issues.
Be familiar with prior authorization
Prior authorization also said to be as pre-authorization is the process of getting the insurance company’s or healthcare plan’s prior approval for specific medical operations before treating the patient. Failure to request prior permission on time may cause delays in patient care result in claim denials and cost money.
- Delays in patient care affect the quality of services and the facility's reputation.
- The time factor for the medical billing team and physicians.
- It is costly and laborious as compared to other processes.
- Policies and procedures required by prior authorization differ from payor to payor.
- Collapse to get prior authorization on time can affect the revenue of a medical facility.
- Inefficient prior authorization leads to an increase in denial ratios.
How to minimize authorization denials
- AI-driven software- Using technological intelligence can cut human labor costs, improve quality, and reduce denied requests. Upgraded tools make prior authorization, insurance eligibility, verification, and benefits checks easier.
- Cross-checking of insurance eligibility- Verification of insurance eligibility and benefits is critical to reducing authorization-related denials, preventing denial percentages from rising above acceptable quality standards, and preserving the bottom line.
- Keep an eye on payor specifications- Many times, denials can be the result of mistakes of the billing team on health plan policy specifications. Each payor may have different policies and coverage benefits. The billing and coding team needs to make these errors.
- Check prior authorization before- Make sure you raise authorization requests for medical services before providing the treatment. Following this step will enable the most possible authorization denials. It also helps with delays in patient services.
- Streamlined approach- A streamlined approach can help in maintaining everything perfectly for any healthcare facility. The whole revenue cycle management process and medical billing process is quite complex and stressful.