Prior authorization can be time-consuming and exhausting for both medical service providers and patients. Orthopaedic providers especially feel the administrative burden, mainly because of the sheer number necessary to perform a procedure. 

Moreover, prior authorizations can take anywhere from three days to a month (assuming there are no compliance issues), which leads to some patients seeking help in the emergency room (and paying emergency room pricing.) Other patients may simply give up on their treatment, or switch to another provider who can get approved faster. 

Here, we discuss how to speed up prior authorization at your practice so you can focus more on patients than paperwork.

1. Open Communication Between the Provider and Payor

Prior authorizations require a lot of back and forth between service providers and insurance payors–why not use that to your advantage? 

Speaking to a patient’s insurance provider with transparency and openness can help you determine the details needed to expedite prior authorizations–required supporting documents, specific procedures that may not need prior authorization, etc. 

You can make this a streamlined process by:

  • Making a reference list of major insurance providers and their contact information
  • Creating a master list of prior authorization requirements for each major insurance payor
  • Documenting or recording interactions with insurance payors so that if you or another team member has the same (or a similar) question in the future, the answer is already there
  • Inquiring about a prior authorization request turnaround time
  • Signing up for insurance providers’ newsletter to get updates about insurance changes and new protocols

2. Take a Proactive Approach to New Insurance

If a patient changes their insurance provider or plan, it also changes the requirements and protocols for prior authorization requests and approvals. This means many practices have to go through the prior authorization request process a second time to get an approval from a new payor.

Consider taking a proactive approach by asking your patients for the most up-to-date insurance information before their appointment. If a procedure is necessary, you may want to ask them if they expect a change in their insurance coverage soon (if their company is changing their insurance provider, for example.)

3. Assign Prior Authorization to the Same Team Members

Instead of trying to get every member of your staff educated about the complexities of prior authorization, designate the responsibility to a select few. These few individuals can:

  • Get familiar with what requires a prior authorization and form requirements
  • Create a streamlined process for filling out and submitting prior authorization forms
  • Stay on top of insurance policy updates
  • Understand why a prior authorization request may be denied (and how to avoid the mistakes that cause denials)
  • Gain a thorough knowledge of healthcare industry standards and updates from sources such as the American Medical Association
  • Explain the basics of the prior authorization process to scheduling staff, so they can schedule appointments for specific procedures in alignment with the expected turnaround time of a prior authorization request

Have these few team members complete all prior authorization forms. Over time, a complex prior authorization workflow will become a simple process that relies almost on muscle memory.

4. Utilize Technology

Technology is helping to streamline almost every area of healthcare–making time-consuming tasks more efficient. Prior authorizations are no exception. From online portals to submit prior authorizations to monitoring submitted requests through software, your practice should be migrating away from traditional methods and adopting new forms of technology that can help your staff and (more importantly) your patients. 

Choosing the Right Partner and the Right Software

When it comes to choosing the right prior authorization, billing, and medical coding software, you need to consider the size of your practice and how much assistance you’ll need.

With a team of dedicated insurance specialists and a cloud-based client-centered portal (scalable for any practice’s needs), partnering with SelectOrtho means that you can speed up the prior authorization process and relieve your staff of the tedious tasks normally associated. 

We essentially remove printed paperwork, reduce human error, and speed up the approval process. With the help of our experienced DME specialists, you’ll eliminate the administrative burden on your staff, so your orthopaedic clinic can run as smoothly, productivity, and profitably as possible.

SPEED UP PRIOR AUTHORIZATION