Navigating Prior Authorizations: 5 Tips to Make Them Easier

May 4, 2022 by Antonio Arias, MBA, CHBME

Topics: Revenue Cycle Management, Practice Management

As you and the staff of your medical practice know very well, there are countless steps, factors, and processes required to keep your operations running smoothly and efficiently in order to deliver great care to your patients.

One such step occurs before services are even rendered—handling prior authorizations from insurance companies or government programs like Medicare that are involved in the patient’s wellness journey. Prior authorizations can be time-consuming and result in headaches for you and your staff, not to mention the patient whose care might be delayed if waiting for a prior authorization to be validated.

Keep reading to learn more about prior authorizations and the challenges involved with them, plus get a few tips to make the prior authorizations process easier for you and your medical practice.

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What Is a Prior Authorization?

Sometimes referred to as precertification or prior approval, prior authorizations entail the physician or medical practice gaining approval for payment before performing a service or prescribing treatment.

Prior authorizations can be easier with our tips

Challenges with Prior Authorizations

While the intention of acquiring prior approval was to streamline the medical care process and keep revenue cycles moving, the opposite seems to have developed over time. Prior authorizations are overused, cost-ineffective, confusing, and often result in delaying important patient care.

5 Tips to Make Prior Authorizations Easier

Prior authorizations can be a huge hassle for your medical practice, your patients’ wellness journey, and your healthcare revenue cycle. Check out these tips to make prior authorizations a little easier to manage:

Know Your Triggers & Avoid Prior Authorizations

One option is to avoid the prior authorization process altogether by trying to not prescribe medications or perform certain services that often need prior authorization. For example, if you continue to run into problems with a certain medication, then see if there’s an alternative or generic equivalent that doesn’t need pre-approval. 

Designate a Staffer to Handle Them

Another tip for making prior authorizations easier for your medical practice to handle is to designate a specific staff member or two, depending on the size and scale of your practice, to handle them. Assigning a team member to manage this part of your medical practice means that your other staff members can work through the many other tasks required to keep operations running smoothly.

The team member who develops a kind of specialty in managing prior authorizations can take ownership of the process and learn the ins and outs of prior authorizations—which makes them efficient and effective at handling this part of your healthcare revenue cycle. Rather than expecting all of your staff members to handle all of your practice’s administrative responsibilities, designating one or two staffers to take lead on prior authorizations can help everyone’s workload.

Utilize Pre-Written Templates & Technology

Creating pre-written templates to get through the prior authorization process can be helpful to your medical practice staff members; instead of having to start fresh for each prior authorization process, they can refer to the template and manually automate the workflow for this component of your operations.

An even better way to optimize your workflow for handling prior authorizations is to have electronic authorizations for your practice.

Customize Your EHR System

Depending on what type of EHR system your healthcare practice is utilizing, there might be a feature or integrated software that can help alert you to prior authorization requirements. Look into this potential tool within your medical practice’s EHR system and be sure that your staff is trained to use it most effectively. 

Keep patients informed of the prior authorizations process

Keep Patients Informed

If the prior authorization process is complicated or frustrating for you and your staff—the medical practice experts—then imagine how it is for your patients who don’t understand the ins and outs of the process. When dealing with a delayed prior authorization process, your patients might feel the blame should fall on your practice rather than the other party; this can stir up anxiety and annoyance for your staff to mitigate.

Get ahead of these patient concerns by keeping your patients in the loop about where you’re at in the prior authorization process. Patient education and patient engagement can be a tremendous resource for your practice—explaining how the prior authorizations process works and roughly how long it takes or any brief anecdotes can help set their mind at ease and align their expectations.

Let NCG Medical Streamline Your Healthcare Revenue Cycle!

Prior authorizations are just one facet of your overall healthcare revenue cycle—and they can be time-consuming and tedious to work through. The medical coding and billing process is even more complicated and stressful! If your medical practice resources are already stretched thin and you don’t have the capacity to rework multiple claims or deal with inaccuracies in your medical coding, then it’s time to partner with a medical billing firm.

NCG Medical has decades of experience optimizing medical practice’s healthcare revenue cycles so they can enjoy an immediate return on investment and focus on what matters most: delivering great care to patients.

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