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HIPAA Compliance in Medical Billing

Hearing only the term “Prior Authorization” can send shivers down the spines of healthcare staff and physicians. The prior authorization under medical billing services has been around for decades; however, not much has been done to reduce the burden on providers or speed up prior authorization process. In a 2019 survey, more than 90% of the participants admitted seeing an increase in prior authorization requests. However, the same respondents also noted that the prior authorizations still drain the clinical resources.

How to Speed Up Prior Authorization Process?

The prior authorization process has many moving parts, affecting patients, payers, and providers alike. While there are some accepted guidelines on some of the issues, other times, many blurred lines also exist in the process.
Here, you might ask yourself how to speed up prior authorization process. Below, we have compiled our tried, tested, and authentic best practices for easing your practice in the prior authorization process.

16 Vital Tips to Speed up Prior Authorization for Medication

  1. Make a master list, listing down all procedures that require authorizations
  2. Meticulously document all denial reasons
  3. Subscribe to payer newsletters
  4. Keep up with the ever-changing industry standards
  5. Give prior authorization responsibilities to same staff member(s)
  6. Inform your scheduling staff regarding the procedures needing prior authorizations
  7. Keep all authorizations in a central location
  8. Leverage and use technology
  9. Make a reference guide for your payor contacts
  10. Regularly document clinical data in detail
  11. Keep a record of all payor correspondences
  12. Formulate a follow-up plan with your staff
  13. Stay meticulous and methodical regarding working authorizations
  14. Request for an estimated turnaround time for completion of authorization
  15. Train and educate patients on the prior authorization process
  16. Remember, patients prefer staying informed, and you being transparent with them

Six Ways to Speed up Prior Authorization Turnaround Times

Let’s explore some more how to speed up prior authorization for medication:

1. Online Payer Submission Portals

Almost all payers are rolling out their online prior authorization submission portals. These portals are ideal to speed up prior authorization, all within 24 to 72 hours. Such online portals enable provider practices to check up on the status of submissions continuously. Doing so significantly reduces the time spent on hold with payers and can considerably reduce the number of calls from your staff members to a payer.

2. Utilizing EHRs

The EHRs have entirely transformed clinical documentation and patient interactions. However, only a few providers effectively use the tools in their EHR systems to automate their workflows. Furthermore, many providers continue to print out and file away their patient charts, even while using EHRs. Getting staff and physicians to effectively use EHRs and its tools for order creation and clinical documentation can massively decrease submission disruptions and speed up prior authorization process.

3. Be Ready for Appeals

It is vital that your authorization specialist trains every clinician in your practice on how to curate a well-articulated appeal of medical necessity. 90 percent of the time, specialists can gather enough material to enforce a successful appeal, but the remaining percentage may require the expertise of a healthcare provider. Here, the specialists can offer the necessary guidance, an outline to follow, and some key elements for inclusion.

4. Minimizing Peer-to-Peer Reviews

Before submitting a prior authorization, it is vital to ensure that your staff is well-equipped and well-versed with the varying payer requirements. Or else peer-to-peer reviews can happen. A prior authorization that takes only 2 days will take over 10 business days to get approval only because a peer-to-peer review is needed. By getting your staff up to speed with the payer requirements, you can successfully avoid peer-to-peer reviews and speed up prior authorization process and approval times.

5. Securing Patient Health Records

Privacy and security of information must always be your priority while working with patient health records or the EHR (Electronic Health Record) prior authorization platforms. All of this must be carefully safeguarded with:

  • Password control
  • System access authorization
  • Access controls
  • WIFI
  • Physical controls
Change is inevitable; therefore, embracing technological changes at the right time is essential. Start with employing prior authorization AI and pull advantages of the technological advancements. By doing so, your practice can effectively remove unnecessary manual work for submitting a prior authorization. Leverage AI and achieve faster prior authorizations to maximize your health system’s ability to deliver better, faster care.

Final Thoughts

There are many effective ways to speed up prior authorization processes in the healthcare RCM industry. These include regular monitoring of PAs and implementing the latest technological standards for prior authorization procedures, medical devices, and therapies, which can and will optimize the prior approvals.

Frequently Asked Questions

Prior authorization is a management practice utilization by insurance companies. Insurance providers require specific tests, procedures, and medications prescribed by healthcare professionals to be evaluated first for establishing medical necessity and cost of care before authorization.
Both pre-authorization and authorization are the same terms. Both correspond to the necessity of getting medical procedures authorized by insurance companies/providers.
Incorrect claims processing leads to authorization denials. It is essential to identify why a claim was incorrectly processed. This warrants that a reason is vital for future prevention.



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