All You Need To Be Aware Of Prior Authorizations
                     All You Need To Be Aware Of Prior 
Authorizations
Prior authorization is an essential element of medical billing and coding, 
particularly when claims are to be settled by an insurance company. It is 
the process of obtaining insurance carrier approval to treat specific 
services. Getting approval from the payer ahead of time increases the 
likelihood of a smooth claims settlement. The procedure involves 
obtaining an authorization number, which providers must include on the 
claim during submission.
While it may appear simple, the process of prior authorization is fraught 
with complications. Providers must be aware of pre-authorization 
guidelines and payer coverage and provide the specific diagnosis on 
reports. Let’s see what all you need to know about the prior 
authorizations
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All You Need To Be Aware Of Prior 
Authorizations
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All You Need To Be Aware Of Prior 
Authorizations
Problems with Prior Authorization
Even though insurers approve most requests, the process can be time-
consuming and involves the administrative hassle of endless paperwork, 
repeated phone calls, and mounting claim piles. This can disrupt or 
delay a patient's access to vital care. 
According to a recent American Medical Association report, 64% of 
providers reported waiting for at least one business day, and 30% 
reported waiting at least three business days. According to the same 
report, approximately 84% reported that prior authorizations result in 
high or extremely high administrative costs, and 85% agreed that 
provider issues with prior authorizations have increased in the last five 
years.
Approximately 60% of doctors received a response at least within one 
business day.
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All You Need To Be Aware Of Prior 
Authorizations
The Influence of the Pandemic on the Prior Authorization Process
According to a recent poll conducted by the Medical Group Management 
Association, 81% of various medical groups have confirmed a significant 
increase in the regulatory burden of prior authorization requirements 
since 2020.
Healthcare providers have complained about a lack of staff to deal with 
the influx of COVID-19 patients. In response to the pandemic, states in 
the United States asked insurers to temporarily waive the PA 
requirements. However, every insurer provider has its own set of PA 
requirements, and many of them were hesitant to accept the waiving 
appeal. 
Furthermore, different states in the United States are taking their own 
distinct approach to a temporary policy change for PA requirements. 
This adds to the uncertainty about policy changes being implemented 
across the country.
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All You Need To Be Aware Of Prior 
Authorizations
First Task: Ensure Correct CPT Code 
Capturing and providing the correct CPT code is required for robust pre-
authorization. However, the exact procedural code must be identified 
and documented before administering the service to the patient. 
Although this is required for clean claims, it is a difficult task. The best 
way to ensure that the code is correct is to contact the physician and 
learn how they intend to carry out the treatment. 
Approximately 85% of physicians believe the burden of Prior Authorization is 
high or extremely high.
Prior Authorization Best Practices:
• Keep Necessary Information Ready:
• Comply with All-Payer Criteria:
• Obtain Preauthorization for Routine Procedures:
• Conduct Regular Audits: 
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  Why Is It Better to Outsource Prior 
Authorization?
The fact that standardizing best practices for prior authorization could 
take years, and as it involves multiple, complex steps, advanced 
technologies such as in-house automation may not be able to optimize 
workflow efficiencies as effectively. Previously, outsourcing was primarily 
used as a cost-cutting strategy. However, operational efficiencies and 
sustained growth have replaced the benefit of lower costs over the year. 
Modern outsourcing medical billing and coding partners such as 
24/7 Medical Billing Services ensure this through strategic thinking and 
innovations to complex processes. This further allows the providers to 
focus on their core services and compete more effectively in a rapidly 
changing market.
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About Us
We are a medical billing company that offers ‘
24/7 Medical Billing Services’ and support physicians, hospitals, 
medical institutions and group practices with our end to end medical 
billing solutions. We help you earn more revenue with our quick and 
affordable services. Our customized Revenue Cycle Management 
(RCM) solutions allow physicians to attract additional revenue and 
reduce administrative burden or losses.
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Contact Us
Media Contact:
24/7 Medical Billing Services
Georgia
3001 Greenfield Drive, Marietta GA
 
Ohio
28405 Osborn Road, Cleveland, OH 4414030068
Texas
2028 E Ben White Blvd, #240-1030 Austin TX, 78741
Delaware
16192 Coastal Highway, Lewes, Delaware 19958, United States
Phone no / Fax :  +1 888-502-0537
                          Email us: [email protected]
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