How to Streamline the Prior Authorization Process in 2021

Streamlining the prior authorization process could be a transition factor in health care in 2021 that eventually changes patient consequences. Based on a review directed by the American Medical Association of 1,000 physicians, nearly 64% of physicians described that they had long delay times for payers to choose the prior authorization that harmed patient outcomes.

That means that understanding the process can improve compliance and enhance approvals for healthcare practices. Investigation of the factor inpatient care among healthcare practices and physicians – the prior authorization is first on the list. Yes, complexities such as approvals for any services like devices, pre-op and post-op visits, testing, and more take a great deal of time and effort from a care provider.

The prior authorization should not be complicated by Health Care 2021 and can easily be simplified by efficient strategies. We discussed in this blog how we could smartly streamline the previous approval procedure.

Ways to Streamline Prior Authorization Process

Gold Card System

According to evidence-based directives, this is a payment process that excludes physicians who order and prescribe medicines reliably or who have high approval rates from PA requirements. If you are an exceptional doctor, you will therefore be happy to give the proverbial gold card, so you can get your patients quick access to the care they have paid for. If your PA demand is confirmed as expected—at, assume, a 90% rate—this is the time for your payers to pay.

Transparent Communication System

Excellent and clear communication of the services which need prior authorization between health care providers and payers would improve the entire PA process. To facilitate this, the Medicare & Medicaid Services (CMS) Centers have announced an initiative program that enables healthcare providers to interact directly through a safe system with a payer platform. This program aims to immediately determine whether prior authorization is necessary for a specific treatment, relevant documents, or medication process.

Insurer’s Authorization Is Also Important

When a patient switches their health insurance provider, a problem usually arises. As a result of the change, a whole new process and repeated protocols are essential before starting treatment. The patient’s health could be severely affected. Also, moving to the new payer should leave the doctors with additional treatment costs—the only way to accept the previous insurer’s prior authorization. Establishing a streamlined procedure will help you provide your patients with quality treatment on time as the unnecessary costs of treatment are reduced.

Speed Up the Prior Authorization Process

The use of manual methods for pre-authorization will slow the process and impact the results of patients. So, accelerating the PA process will help you get better results, but how can things be accelerated quickly? Some of the key tactics for accelerating prior authorization include…

Appoint an authorization expert

  • Use advanced technology, such as pre-authorization electronic software or emerging
    PA medical billing software.
  • Register for newsletters for the payer.
  • Clinical data are often documented.
  • Create a successful PA follow-up plan.
  • Educate your patients by giving special training sessions on prior authorization.

Automation of Prior Authorization Process

The prior authorization of each paper cannot be examined manually in any practice. Automation is one of the best scheme to simplify the PA process by identifying accurate drugs and treatments quickly. Adopting automation solutions such as electronic PA would drastically eliminate manual processes that consume time and maximize revenues.

  • Automates prior approval tasks
  • Reduces the administrative and physician burden
  • Provides patient payment information in real-time
  • More precise claims
  • Low denial rates
  • Improved productivity in practice

Follow these strategies to simplify your prior authorization process in 2021, leading to higher income and better care for patients. Need help with your Prior Authorization Process, contact Right Medical Billing at 281-864-0448.

Read this…

5 Tips to handle prior authorization in RCM

 

 

Written by: Kaynat Ishfaq

Author has been writing from last 4 years in Healthcare and medical billing field.

Shahzad H

Revenue Cycle Management Consultant, Medical Billing & AR Audit, Free Standing Emergency Rooms, Micro Hospitals, Compliance, OON Negotiations, Digital Marketing

 

 

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prior authorization process, medical billing, medical billing and coding, revenue cycle management, accounts receivable recovery, free-standing er billing, free-standing emergency room, out of network negotiations, prior authorizations

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