Unlocking the Secrets to Successful Prior Authorization for SNF

Did you know?

As per America's Health Insurance Plans (AHIP), prior authorizations are required to make sure that the patient receives a safe, medically necessary, and suitable treatment.

Health insurance companies have the distinct advantage of observing how patients use their coverage and what treatments they have already availed. The prior authorization process helps avoid duplication and unnecessary tests and treatments while ensuring that the patient receives the best care possible for their condition. Though prior authorizations are required in healthcare, they can be costly for practices and facilities such as skilled nursing (SNF).

Do you need help with prior authorizations in your skilled nursing facility? Is it affecting your ability to offer timely patient treatment because of denied prior authorizations?

If YES! You're not alone.

There is a need for tried-and-true recommended practices to make prior authorization easier. Let’s unlock the secrets to successful prior authorization for SNF:

• Educate on Documentation Requirements

It is critical that physicians understand the patient’s prior authorization process. They should be aware of the patient's insurance coverage and whom to notify if the process changes in the middle of the procedure. However, they should also be trained on the entire procedure as their documentation is so vital to the process.

Ensure they understand conservative treatment because insurance companies typically want to know if it failed before authorizing a more intrusive surgery. Inform your physicians about your difficulties and provide comments as if they refuse to listen, gather and deliver - the ultimate result will be the lost revenue figures to them.

• Collect Accurate Information

Patient intake is frequently the root cause of missing prior authorization, so be sure all the information you collect for prior authorization is correct. Make sure you use the same exact spelling for the patient's name and address on the prior authorization as you do in your systems.

Most Practice Management (PMS) and Electronic Medical Records (EMR) Systems copy over subscriber information from the patient, so train your intake team on the ins and outs of the payers.

If the subscriber is not the patient, having that subscriber information will ensure the process continues.  Check that you have the correct payer's claims address, as many payers cross state lines and have several addresses. The prior authorization team wastes time if they don’t know where to seek that prior authorization.

• Work on your Denials

Denials are inconvenient, but they can be turned into a learning opportunity. Working through your denials will assist you in avoiding them in the future. To determine why the denial occurred in the first place, your practice management system should include denial reports.

Look for patterns in these reports to figure out what happened. Then, collaborate with your PMS/EMR vendor to design a system that makes your software work for you. Create reports, for example, that alert your team to combinations of payers and procedures that require prior authorization.

Outsourcing Prior Authorization to Speed Up the Process!

Undoubtedly, most patients are waiting for prior authorization, affecting their care. That's why it's vital to grant patients prior authorizations as soon as possible - so you will be paid, and your patients can obtain the care they require.

The good news is that you can lessen your prior authorization burden by organizing your workflow, emphasizing developing relationships, enhancing accuracy, and keeping diligent. All this is possible by outsourcing SNF prior authorization tasks to the company, like 24/7 Medical Billing Services. In fact, outsourcing is an excellent approach to connecting with professionals and experts who may have solutions you have yet to try.

See also: Medicare Coverage Of Skilled Nursing Facility Billing