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Best Practices for Automating Prior Authorization Process

November 14, 2017

Patient_Prior_Authorization_Process.jpgObtaining prior authorization for services can place a significant burden on practice staff, but this critical step in the healthcare reimbursement process causes substantial challenges if skipped. If prior authorization is not performed, clinicians may find that they have performed unnecessary or duplicative services. These prior authorization and insurance verification best practices allow you to minimize these time-intensive processes while still insuring a high quality of care for your patients and a high payment rate from payers. 

Insurance Verification

Often the first step in the process includes verifying a patient’s insurance. It is crucial that your office staff be fully trained on the importance of always checking insurance eligibility before each appointment, as insurance information can change at any time. Benefits and authorizations can shift with new or different insurance, and patients may not even realize that there’s been a change. 

Reducing the Disconnect

Medical billing software professionals are having productive conversations with payers, yet there are still pain points between patients, payers and providers. Providers may share information based on their understanding of insurance coverage, yet patients hear a different story from providers. Some of this challenge can be overcome by working with a third-party medical billing practice to review and manage prior authorization requirements and ensure that coding is accurate.

Related Topic: True Impact of the Patient Prior Authorization Process

Obtaining Authorization

There are multiple factors to keep in mind when obtaining prior authorization for any particular procedure, with the first step being to determine whether or not the particular procedure even requires that this step be completed. If so, automated authorization solutions may save hours from your process on a weekly basis and reduce your overall administrative burden. However, there is some concern that aggressive prior authorization programs can place the importance of cost-savings above that of patients, which is not optimal for anyone involved. Recent studies show that providers and primary care nurses may spend up to 13.1 hours per week, while clerical staff represents an additional 5.6 hours per week, simply on work revolving around obtaining and validating prior authorizations.

Reducing Problem Payers

If you have one payer in particular that requires extensive prior authorizations and only represents a small percentage of your overall revenue, you may consider not renewing that contract when the time comes. The same tenet holds true for payments: if you’re noticing that one particular payer is slower or pays reduced dollars based on claims, keeping tight control of your payment management solution provides you with the details you need to complete this analysis and decide not to renew.

Consistency is Critical

Understanding the front office processes involved in obtaining, validating and recording prior authorization is critical to success. When you are not sure exactly how this process is happening, it’s almost certain that there are inefficiencies involved that can be wasting precious hours of time that could be spent with patients. Automating this process as much as possible allows you a higher degree of control all around. The importance of accurate data cannot be overstated, as this is the primary reason for prior authorizations that take two or even three rounds of review before procedures or treatment plans are approved to proceed. Understanding where bumps are in the process is much simpler with an automated solution that manages patient data, prior authorization, coding and billing in one place. 

Our medical billing service professionals are available to help you better understand prior authorization processes requirements, and how you can bring these optimization tips into your medical practice. 

Ready to improve your overall medical billing process, reduce administrative overhead and boost patient satisfaction with your practice? We enter in providers schedules prior-authorization and patient eligibility details prior to patient visit. This helps front desk to know what services can be provided and exactly how much to collect before patient see the provider. To know more about please contact me today at 770-666-0470 or via email to


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