If you’ve ever experienced the headache of trying to get a prior authorization approved, you’re certainly not alone!   Unfortunately, prior authorizations have become somewhat of an industry standard for medical practices and their patients. But navigating the process can be complicated, tedious, and time-consuming – all resulting in extra work that takes away from what matters: getting your patient the care they need.

In this blog post, we’ll explore why securing prior authorizations is tough for medical practices and what resources are available to help!

Prior authorization, also referred to as pre-approval or precertification, is a process used by medical insurers to ensure the services and treatments you receive are covered under your plan. Prior authorization helps ensure that patients only receive medically necessary care that is supported by published clinical evidence and practice guidelines.  The process typically requires an initial review of the proposed care to assess whether certain criteria are met before approval for payment or coverage can be granted.

One major problem with the prior authorization process it is often very time consuming and complicated.  From the start, providers have to submit paperwork for each individual patient for every treatment that requires pre-authorization. The paperwork may include detailed medical records and information about the proposed care plan, which can add an additional layer of complexity to an already demanding task.

Furthermore, the process often involves back-and-forth communications with insurance companies, in order to get all the details sorted out before any care is provided – this can be especially challenging if there are multiple providers involved in providing such care.

Another key issue relates to insurance companies denying authorization requests at a high rate or changing their requirements without notice – leading to increased operational costs or even service delays or cancellations due to lack of coverage or reimbursements. It also leaves patients frustrated when they find out that a necessary treatment isn’t covered because it wasn’t properly authorized beforehand.

Finally, some studies have also shown that provider organizations often struggle managing all their prior authorization activities due to limited technology resources available – from inefficient paper processes which require manual effort as well as slow technological infrastructure used by many organizations which makes it hard for them not only comply with changing government regulations but also meet provider/patient demands for quick responses regarding authorization decisions.

As your billing partner, Reliance® can assist you with the process of securing prior authorizations in several beneficial ways.  First, we can simplify the administrative workload associated with obtaining approvals and notifying stakeholders.  Second, our team can ensure timely and accurate outcomes as experienced insurance specialists review requests for accuracy and completeness. Lastly, we can help you reduce overhead costs by allowing you to reallocate staff resources where they make the biggest impact – enhancing patient care!

So, stop struggling to get your prior authorizations approved!  Let us take care of it for you and put this hassle behind you, once and for all. 

Call us at 717-740-2622 or email: info@reliancembs.com.

At Reliance® – Medical Billing Made Simple®