How to Optimize Prior Authorization: Tips and Tricks for Providers

MT: Tips & Tricks for Physicians to Optimize Prior Authorization

MD: Prior authorization burdens physicians and impacts care. Use PMS and EMR systems to optimize prior authorization, manage denials, and eliminate disconnect.


The wait for a prior authorization to be approved can cause patient anxiety and limit their care. However, from the providers point of view, the main focus on the prior authorization is getting it approved so that you can be reimbursed

Managing the patients emotional response to the prior authorization waiting gain can be less stressful if you include a strategy to work with the patient, and communicate with them, setting clear expectations. Implementing these conversations as part of your workflow and optimizing your prior authorization process with a much more streamlined process can result in two outcomes:

  1. Lowered patient anxiety
  2. Faster time to treatment
  3. Improved financial and operational efficiency for your practice

Tips to Optimize Prior Authorization

The process of obtaining prior authorization involves numerous manual steps and parties, resulting in errors. Lengthy medical reviews necessitated by prior authorization may delay care and create confusion for physicians and patients.

You can reduce the time required to treat a patient by automating the entire prior authorization procedure as soon as possible in the revenue cycle. It reduces the likelihood of errors occurring and the quantity of labor that must be performed manually.

Let’s find out the useful tricks to optimize prior authorization.

Utilize Your Electronic Medical Records (EMR) Systems

Start by maximizing the huge investment that almost all providers have made in their EMR’s.. By better utilizing your reporting functionality, you will open up the ability to better track your prior authorizations and where they are in the chain of: Submit / Approved / Denied / Appeal. These reports must, at the minimum, show the date that the authorization is needed and where it is in the process. However, having the report will be of no use, unless you have a set of eyes on it each day, and ensuring that follow ups are occurring, as needed in order to ensure the PA is complete before the patients appointment.

Work on Denial Management

Denial are a burden, but they should also be considered as a learning opportunity. Understanding the cause of your denials will help you prevent them in the future and ensure that future prior authorizations include the necessary documentation to prevent a reoccurrence. Utilizing a reporting system that gives you insight into what transpired will allow you to identify patterns. The next step is collaborating with internal and external expertise that will allow you to create a system that can capture the necessary information in the authorization submission process.

Know and Track your Policies

Most payers put their coverage rules online, they are transparent and accessible. It is important that you continue to monitor revisions and yet keep old policies. The importance of keeping historical policies on record mean that you have access to it, in cases of the need to If a payer wishes to appeal a 2021 rejection, they must use a 2021 policy, but they typically don’t know which one. However, by maintaining historical emails, bulletins, and other insurance-related documents, you have the ability to review them when fighting a denial.

Outsource Prior Authorization to Experts

Given the time and expertise needed for successful prior authorizations, experts are needed. However, because this is a ‘cost center’ practices are induced to assign their lowest cost and lest experienced employee to this role. It will take longer and may lead to errors. In many cases, making the choice or using an outsourced service provider will  save your medical facility money over time, and ease the stress of the prior authorization process. Further, as prior authorization specialists are constantly focused on ensuring that they stay updated on new policies and regulations, it ensures that you are always up to date with the documentation and information that you need to submit.

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