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7 Effective Tips to Expedite Medical Prior Authorization for Healthcare Providers

4/11/2023

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​7 Effective Tips to Expedite Medical Prior Authorization for Healthcare Providers
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​7 Effective Tips to Expedite Medical Prior Authorization for Healthcare Providers
​Discover key strategies healthcare providers can implement to speed up the medical prior authorization process, ensuring timely access to necessary treatments.
In the complex world of healthcare, navigating medical prior authorization can be a daunting task for both patients and providers. It's crucial for healthcare providers to streamline this process to ensure patients receive timely access to necessary treatments. In this article, we share seven effective tips to expedite medical prior authorization, backed by references and expert insights.

Develop a Comprehensive Understanding of Payer Policies
Understanding the specific requirements and policies of each payer is crucial in expediting the medical prior authorization process. Make sure your staff is well-versed with each payer's guidelines and update them regularly on any changes (1).

Utilize Electronic Prior Authorization (ePA)
Leveraging ePA technology can significantly speed up the process by reducing paperwork and minimizing human errors. Many payers and pharmacy benefit managers (PBMs) have implemented ePA systems, which can be integrated with your electronic health record (EHR) system (2).

Maintain Accurate and Complete Documentation
Ensure that all necessary documentation is accurately maintained and readily available to submit with the prior authorization request. This includes clinical notes, treatment plans, and any pertinent diagnostic results (3).

Train Your Staff
Educate your staff on the nuances of the medical prior authorization process and the importance of accuracy and timeliness. Investing in ongoing training will not only expedite the process but also minimize errors and rejections (4).

Streamline Communication
Establish clear lines of communication between your staff, payers, and patients. This helps in promptly addressing any issues or questions that may arise during the medical prior authorization process (5).

Track and Measure Performance Metrics
Monitor key performance metrics such as approval rates, turnaround times, and staff productivity to identify areas of improvement and optimize your processes (6).

Outsource Medical Prior Authorization Tasks
Outsourcing medical prior authorization tasks to a reputable company like GoHealthcare Practice Solutions can save time and resources while ensuring accuracy and compliance. Visit their website at https://www.gohealthcarellc.com to learn more about their services.
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​7 Effective Tips to Expedite Medical Prior Authorization for Healthcare Providers
​By implementing these tips, healthcare providers can expedite the medical prior authorization process, improving patient satisfaction and overall practice efficiency.

References:
  • American Medical Association. (2018). Prior authorization and utilization management reform principles. Retrieved from https://www.ama-assn.org/system/files/2019-06/principles-with-signatory-page-for-slsc.pdf​

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    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio, MSC, CSPPM, CRCR, CSBI, CSPR, CSAF is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

    Current HFMA Professional Expertise Credentials: 
    HFMA Certified Specialist in Physician Practice Management (CSPPM)
    HFMA Certified Specialist in Revenue Cycle Management (CRCR)
    HFMA Certified Specialist Payment & Reimbursement (CSPR)
    HFMA Certified Specialist in Business Intelligence (CSBI)

    View my Profile on Linkedin
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  • About
    • In the News
    • Privacy Policy
    • Terms of Use
  • Leadership
  • Contact Us
  • Testimonials
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • Readers Questions
  • Artificial Intelligence Division