Prior Authorization Hurdles: Reclaim Your Time and Revenue with Smarter Strategies

The administrative burden of prior authorization can feel a never ending battle to get paid. The frustration is real: 75% of physicians report spending over 10 hours per week navigating complex requirements, and denials average a staggering 7.1%, impacting your revenue and delaying much-needed care (AMA, 2023). In this blog post, we will share ways to simplify this process and reclaim your time and the money owed to you.

Understanding the Challenge:

Unfortunately the roadblocks created by insurance companies to obtain prior authorization often feels like a barrier, not a safeguard. The sheer volume of requests, varying payer rules, and lack of standardization create a maze even the most knowledgeable  team struggles to navigate. These unnecessary hoops can create physician burnout, staff stress, and ultimately, compromised patient care.

Streamline Workflows for Success:

• Invest in Technology: Consider platforms that integrate with your EHR and automate tasks like eligibility verification, pre-filling forms, and submitting requests electronically. This improves accuracy, saves time, and reduces manual errors.
• Build a Skilled Team: Train your staff to understand payer rules, develop strong communication skills, and follow-up proactively on requests. Consider supplementing your team with live virtual assistants (HVAs) trained specifically in navigating prior authorization requirements. Their expertise and remote flexibility can alleviate your team's workload significantly.
• Standardize Your Approach: Create workflows and templates for different types of authorization requests to increase efficiency and consistency. Use data analytics to identify patterns in denials and adjust your approach accordingly.

Collaboration is Key:

• Develop Relationships with Payer Representatives: Build rapport with key contacts at insurers to understand their processes and address concerns proactively.
• Utilize Payer Resources: Many payers offer online portals, training materials, and even dedicated support lines to help navigate their authorization requirements. Take advantage of these resources!
• Advocate for Change: Join forces with other healthcare professionals and organizations to lobby for standardized and streamlined prior authorization practices.

Optimize Team Structure for Results:

• Interdisciplinary Teams: Include clinical and administrative staff in authorization discussions. Utilize your HVAs' research and communication skills to gather evidence and submit compelling requests.
• Patient-Centered Approach: Involve patients in the process whenever possible. Keep them informed, address their concerns, and document their preferences in authorization requests.

Conclusion:

Remember, you're not alone.. By investing in tools, training, and setting up strategic workflows you can navigate the prior authorization maze with greater efficiency and minimize revenue loss. And, remember, your Doc Assist Me HVAs can be invaluable partners in streamlining this process, helping ensure you get paid for the services and care you provide. 

Sources:

• American Medical Association. (2023, March). Physician Practice Costs & Revenue Report 2023.
• Health Affairs. (2022, May). Prior Authorization and Physician Burden: A Growing Concern.
• American Academy of Family Physicians. (2023). Prior Authorization Toolkit.