Authorization – Is It Really Worth It?

For those of us who offer specialty services, we are often faced with the laborious task of completing prior authorization for patient visits. Authorization is very straight-forward – it either leads to visits approved and payment, or denials. In a 2013 study published by the Journal of the American Board of Family Medicine, it was determined that prior authorization tasks can cost up to $3,430 per full-time physician. With all of the time and money we pour into authorization, many of us are asking ourselves – is it really worth it?

As a manager overseeing the practice management operations for a network of outpatient private physical and occupational therapy practices, I am one of the first ones to say that although prior authorizations cost us a lot, this service is necessary. Authorization not only determines whether or not we will be paid for services, but it also greatly impacts the patient’s experience and perception of our practice(s).

Patients come to us in the most venerable times of their lives – when they are sick and/or in pain. The last thing they want to worry about is whether or not their insurances will approve their treatment. They need someone else to work for them on their behalf; someone they can trust. When you dedicate yourself to ensuring patient visits are authorized, you are giving your patients further confidence in your practice and create raving fans, excited to share their experience with others.

Taking a look on the flip side, if you don’t successfully complete prior authorizations, visits are not approved and your patients are forced with the choice of self-discharging or paying for services out-of-pocket. This not only hurts your reimbursement (collections from patients are harder to obtain and most often, you will need to provide a payment plan or discount services), but can greatly harm your credibility. Unfortunately, patients are more likely to share negative experiences with others than positive ones. In fact, it takes 13 positive comments to make up for one negative one. And in today’s world, these negative comments are available online and easily found by other patients seeking a provider. I guarantee you don’t want to be labeled as “the expensive practice who couldn’t work with my insurance company even though they were in-network” to these potential patients.

So, how can we make such a labor-some process easier for us and still be successful? Luckily, we live in the age of technology. Several EMR solutions offer tracking or color-coding to remind you and providers of upcoming authorizations. Check into your solution to see if this is an option for you. In addition, the individual manning the front desk can be a back-up and assist in teeing up you and/or providers of a patient’s authorization need or status. This second pair of eyes will help you stay on schedule and not overlook any patients. Lastly, educate all providers on the importance of documenting the necessity for skilled medical care, as this will greatly impact the authorization decision. Providers must realize that it is their responsibility to the patient to complete their documentation fully. In essence, they are accountable for the authorization decision.

Patients are dependent upon our commitment to their care. Yes, it may cost a lot in labor to complete prior authorizations, but it is worth the confidence boost we give our patients. When they feel like we are their advocate, working for them, they will become raving fans and lifelong customers. Prior authorization impacts not only our financial stability, but also our credibility.