Top 5 Prior Authorization Mistakes That Can Delay Payments. Avoid Them with TherapyPM Now!
Have you ever submitted a claim to receive faster reimbursement for your hard work, only to face delays or denials? At such times, you may wonder where you went wrong. If yes, you are not alone!
Studies suggest that prior authorization mistakes, even small ones, can lead to significant claim denials and delays. Prior authorization errors are the real culprit here, and they can cost your practice valuable time and revenue.
Also, since most practices still require paperwork, this can often lead to manual errors. Switching to automated software like TherapyPM can help prevent this authorization mishap!
In this blog, we will explore common prior authorization mistakes, how TherapyPM can streamline them, and ways to submit requests efficiently.
Key Takeaways
- Prior authorization errors like missing information, incorrect codes, and late submissions can cause claim denials and delay reimbursements.
- Handling prior authorizations manually can consume time and result in errors, affecting revenue and patient satisfaction.
- Submit authorization requests early and track their status regularly to prevent delays and ensure timely approvals.
- TherapyPM automates and simplifies prior authorizations with real-time tracking, automated expiration reminders, and compliance-friendly scheduling to reduce errors.
- Integrate TherapyPM into your practice to reduce administrative burdens, prevent claim denials, and ensure a seamless prior authorization process.
Importance of Prior Authorization
Prior authorization is crucial for therapy practices as it ensures that insurers pre-approve the services. It also helps reduce claim denials and accelerates reimbursements, leading to a smoother revenue cycle.
However, managing authorizations manually can get overwhelming and prone to errors. To minimize mistakes and avoid payment delays, carefully review all information before submitting claims to insurance companies.
Common Prior Authorization Mistakes Delaying Your Payments
Here are the five common prior authorization mistakes that might be delaying your payments:
Missing or Incomplete Information:
Therapists often forget to re-check the information before sending claims to the insurance companies. This often creates havoc. Missing, incorrect, or incomplete information results in claim denials, therefore, therapists may have to resubmit/appeal their request for claims.
The process of resubmission or request appeal can get daunting and time-consuming. It can be a headache to go through it all over again. As a result, this can significantly impact patient care, causing dissatisfaction among patients.
Incorrect CPT Codes or Diagnoses:
Insurance companies will deny the claims if they detect inaccurate or mismatched codes. Therefore, providers may have to correct and resubmit them, using additional time and resources. Frequent errors can lead to an increase in scrutiny, audits, and investigations. As a result, therapists may face penalties or non-compliance issues. Additionally, insurance companies might levy fines or exclude those therapists from insurance networks. Due to this, therapists may hesitate to offer services, resulting in declined patient care quality and loss of revenue.
Submitting Requests Too Late:
This is one of the most common mistakes in the authorization process. Insurance companies often require pre-authorization before rendering services, and processing times also vary depending on the payer. When you submit the request too late, you may face claim denials, service delays, or urgent appeals. This can further complicate the reimbursement process.
Not Tracking Expiration Dates:
Every approved authorization comes with an expiration date. Before submitting the claims for services rendered, it is mandatory to track authorization deadlines, or the claim may be denied. This can result in payment delays and revenue loss for the practice.
Failure to Follow Up on Pending Requests:
Even after successfully submitting the authorization to the insurance company, you must follow up regularly. But often, therapists assume that the approval will happen automatically once they submit. That is not true. There are various possibilities for delays, too – missing information, payer backlogs, or additional documentation requests. If therapists fail to follow up on these pending requests, it will eventually lead to missed deadlines and claim denials.
How TherapyPM Solves These Issues?
TherapyPM is an all-in-one practice management software designed to streamline administrative tasks. The software caters to multidisciplinary therapists – ABA, mental health, physical, speech, occupational, and pediatric.
Managing prior authorizations manually can be daunting and increases the risk of errors. This also puts you at risk for revenue loss, client dissatisfaction, and reputational damage. It’s not worth it.
Making mistakes is human; however, don’t let it define your practice and its future. TherapyPM allows you to manage authorizations seamlessly within the same tab. All the prior authorization information will be recorded securely. You can track the authorization statuses very easily here and take action soon.
TherapyPM offers comprehensive features to reduce claim denials and streamline your prior authorization management:
Intuitive Authorization Management Interface:
TherapyPM consists of a user-friendly interface that enables providers to input and access prior authorization details effortlessly. They include expiration dates, session limits, and approved services. The software records data accurately and ensures seamless availability, reducing the risk of errors and omissions.
Compliance with Authorization Guidelines:
The platform enables therapists to schedule appointments in strict accordance with authorized units and guidelines, ensuring compliance with payer requirements. TherapyPM prevents overutilization and potential billing issues by aligning service delivery with authorization limits.
Automated Notifications for Expiring Authorizations:
TherapyPM alerts providers about upcoming authorization expirations in advance, for instance, before 30, 60, or 90 days. These timely reminders facilitate quicker renewals, ensuring uninterrupted patient care and reducing chances of claim denials from expired authorizations.
Real-Time Authorization Tracking:
With TherapyPM, providers can monitor the status of authorizations in real-time and manage pending requests efficiently. The dashboard offers insights into authorization utilization, enabling providers to address issues promptly and maintain a seamless workflow.
Best Practices for Submitting Accurate Prior Authorization Requests
Double-Check All Information Before Submission:
Review patient details, provider information, and insurance data thoroughly before sending an authorization request. Even minor errors in personal information or missing documentation can lead to denials and delays.
Use the Correct CPT Codes and Diagnoses:
Remember to verify and double-check whether the CPT and ICD-10 codes match the services provided. Stay updated with coding guidelines and payer policies to reduce rejections and avoid compliance issues.
Submit Requests Well in Advance:
Never wait until the last minute to submit the prior authorization requests. Approval timelines might vary according to the payer, therefore, early authorization submissions can prevent service delays, urgent appeals, and reimbursement issues.
Track Authorization Expiration Dates:
Monitor and track authorization expiration dates regularly to prevent claim denials due to outdated approvals. Set up reminders or use automation tools to renew prior authorizations on time.
Follow Up on Pending Authorizations:
Check the status of submitted requests regularly. Contact payers if delays happen due to missing documents or additional requirements. Regular follow-ups can prevent missed deadlines and ensure timely approvals.
Conclusion
Prior authorization mistakes can severely affect your practice’s revenue, patient satisfaction, and overall efficiency. Errors like missing information, incorrect dates, delayed submissions, and lack of follow-ups cause claim denials, thereby delaying your hard-earned payments. With TherapyPM, you can easily automate and streamline your prior authorization process, reduce administrative burdens, and ensure compliance with payer guidelines. The software uses intuitive authorization tracking, automated expiration reminders, and real-time updates to help recognize potential denials and secure timely reimbursements.
Are prior authorization errors disrupting your workflow? Don’t worry anymore! Switch to today – start a 30-day free trial with us. Experience hassle-free practice management while increasing your revenue with us!
Frequently Asked Questions (FAQs)
1.Why is prior authorization important?
Prior authorization helps reduce claim denials and enables faster reimbursements, ensuring a smoother revenue cycle for your practice.
- How do prior authorization errors affect my practice?
Errors like missing or incomplete documentation, incorrect CPT codes, or late submissions can lead to claim denials and payment delays. This affects your practice revenue, disrupts patient care, and increases administrative workload.
- What are some common mistakes in the prior authorization process?
Common mistakes in the prior authorization process include:Missing or incomplete patient and provider informationIncorrect or outdated CPT codes or diagnosesSubmitting requests too lateNot tracking authorization expiration dates regularlyNot following up on pending authorization requests.
- How does TherapyPM help prevent these errors?
TherapyPM automates and streamlines the prior authorization process with the following features:
- Intuitive management interface
- Automated notifications for expiring authorizations
- Real-time tracking of pending requests
- Strict adherence to compliance guidelines
These features reduce manual errors and ensure timely submissions.
5. What are the best practices for managing prior authorizations?