How to ensure a succcessful authorization process
Gone are the days where authorizations were less of a requirement.
According to a 2019 study from the American Medical Association, 86 percent of physicians report that authorization burdens have increased during the last five years and 43 percent claim they have ‘increased significantly’. Fast forward to Q3 2020, we believe authorizations are required more than ever before due to COVID-19.
Then there is also the delay aspect of the authorization process: 64% of physicians wait one or more business days for receiving approvals and 91% state that this process leads to delays in accessing necessary care!
Remember it is your responsibility as a practice to keep track of which procedures require authorizations on a consistent basis.
5 tips that will ensure a successful authorization process.
Keep in touch with payers
Maintain consistent communication with all payers on which procedures require pre-authorizations and consider creating a pre-authorization database. Make one person responsible for this database and keep it updated periodically as this will help reduce confusion and improve efficiency.
Verify procedure authorizations with the right person
Never assume that a service does not require an authorization unless you have proof from a senior level employee on the payer side.
Make sure all authorization requests are captured on a recorded line.
Take notes of who you talk to
If an agent tells you that a procedure does not need authorization contrary to what your records state, take the agents name, phone number, employer id and reference number for the call. This will aid in your appeal should the claim deny for no authorization.
Submit requests ahead of time
Ensure to submit your authorization request at least a week before the procedure if possible to avoid any inconvenient delays for your patient.
The SkyCom promise
We are HIPAA and PCI DSS compliant
An authorization is not a guarantee of payment but it will most likely result in a claim denial if you don’t get one.
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