Physicians, Know How Delayed Prior Authorization Causes You Revenue Opportunities
by admin |January 22, 2025 | 6 comments,
In a time-sensitive and detailed-focused world of healthcare, billing is crucial to maintain a healthy revenue stream. The most common hazard a physician faces is missing out on significant revenue because of delay in obtaining prior authorization. This important, yet time consuming process ensures medical services and procedures are covered by insurance before they have been performed. When physicians fail in submitting or completing the prior auth process on time, they lose out on reimbursements. This delays payments and hence face claim denials.
Prior Authorization and Its Importance
Health insurance companies require prior authorization. Through this, insurers ask healthcare providers to get the approval before performing certain procedures, tests, or treatments. The goal is that insurance companies cover the cost of service, making sure that the treatment is medically necessary, cost effective, and appropriate for the patient's health needs.
When physicians submit a request for prior authorization, insurance companies review the details of the procedure. This is when they decide if it is covered under the patient’s policy. If approved, physicians then move forward with the treatment confidently, knowing that the costs will be reimbursed to them by the insurer. In any case if the process is delayed or overlooked, it leads to missed revenue opportunities
How Does Delayed Prior Authorization Impact Physician Revenue?
One of the most immediate impacts of not choosing prior auth on time is claim denial. Most insurance companies often require prior authorization for procedures, treatments, and tests that are deemed non-routine or expensive. If a physician proceeds without the approval, the claim is likely to be rejected. Even if a physician submits the authorization later, chances of the insurer rejecting the claim is still there, stating that it was filed too late. This results in delayed payments and the additional administrative work of re-submitting the claims.
Getting missing prior auth approvals is an extremely time-consuming task. It takes away from the valuable time a provider could dedicate to treating the patients. This workload increases overhead costs of the practice, affecting its overall profitability. Staff members should follow-up with insurance companies, resend them the documentation, and communicate with patients. All these tasks increase the operational costs.
When physicians fail to get the prior auth on time, patients face delayed care or have to deal with the unexpected out-of-pocket expenses. This leads to dissatisfaction, especially if the patient is not informed in advance about the potential costs. One negative patient experience significantly affects a practice’s reputation. Affecting patient retention in the future, leads to fewer referrals and ultimately causes loss of revenue.
Without timely prior authorization, a practice faces irregular cash flow because of delayed reimbursements collections. This impacts the ability to pay off staff members, cover operating expenses or invest in newer technologies and equipment. A consistent and smooth revenue stream is essential to keep the practice running financially healthy. Any delay in authorization leads to direct cash flow disruptions.
Ensuring Timely Prior Authorization
Avoid missing out on revenue caused by delayed prior authorization. A few best practices to follow are:
- Automating the process to streamline the prior authorization approval makes it quicker and easier. Automation tools and healthcare software go a long way in helping keep track of authorization requests and deadlines.
- Handling prior authorizations internally is overwhelming while managing the clinical work. Outsourcing this task to a trusted partner that specializes in prior authorization is a smart approach. These specialists ensure authorization is handled promptly and professionally.
- The administrative team has to be made aware of the importance of timely submitted prior authorizations. They also need to be well-trained in how to submit them accurately. Regular training prevents delays caused by errors and miscommunication.
- A well-organized system that tracks all prior authorizations requests and approval is essential. Physicians and staff need to have access to a centralized platform that allows them to follow-up on requests and avoid missing deadlines.
Instapay Healthcare Services: Your Partner for Timely Prior Auth
A medical billing and coding specialist, Instapay Healthcare Services offers all round solutions to healthcare providers. We understand the challenges physicians face in managing their billing and coding process. Our comprehensive medical billing and coding solutions include timely and accurate prior authorization support. Dedicated to making sure your practice is compliant with insurance requirements, we submit your claims well in time. Following industry best practices, Instapay Healthcare Services handles prior authorizations requests efficiently and reduces the risk of claims denials that cause loss of revenue.
All our processes are automated to keep human errors at bay. As a trusted partner by many practices, Instapay Healthcare Services has built a reputation to submit prior auth requests promptly and professionally. By outsourcing us, your overhead costs of managing an in-house team is reduced. We have employed advanced technology and software to take care of everything so that you are free to not make expensive investments in technological equipment. We are constant and diligent checks, we track approvals for any follow-up or deadline.
Taking the burden off of your shoulders, focus on delivering exceptional care to your patients whilst we take care of prior authorization for you.