Introduction 

For those operating within the US healthcare industry, the deep-seated aversion to prior authorizations among healthcare providers, especially sleep study operators, is no secret. This insurance-based requirement can significantly postpone necessary treatments. 

An American Medical Association (AMA) survey reported that "securing prior-authorization or even re-authorization" before performing a sleep testing procedure "always leads to care delays in 14% of cases", with a stunning "42% of cases frequently experiencing delays". 

Despite the severe implications of these delays, decision-makers at sleep centers have yet to implement substantial measures to manage these pre-authorizations as efficiently as possible. 

Sleep Study Prior Authorization services: In-house teams vs. outsourced RCM companies 

The aforementioned AMA survey also pointed out that "35% of physicians employ staff solely for prior auth processes". 

However, even with dedicated in-house teams, issues such as inadequate training, failing to keep abreast of changes to insurance preauthorization guidelines, administrative burden due to heightened patient volumes, and cost-related challenges render the prior authorization and sleep study billing services markedly inefficient. 

Here are the main differences between how RCM companies and in-house teams at sleep centers approach PAs: 

1. Payer relations: A dedicated pre-authorization specialist, tasked solely with timely PA completions, typically processes around 10 authorizations per day. They maintain regular contact with various insurers, both private and government-based, to ensure the shortest possible TAT. Their robust payer relations facilitate swift PA completions. 

1. Administrative burden: Operational teams at sleep clinics often juggle various tasks alongside timely PA completions, particularly during periods of high patient volumes. In contrast, staff at RCM companies dedicated to PAs focus solely on insurance verifications, resulting in greater productivity and accuracy. 

1. Leveraging technology: Teams responsible for pre-authorization at RCM companies utilize various automation tools that conduct background checks to ensure no PA documents or forms are missing. These tools also send reminders for follow-ups and automate essential manual tasks to reduce errors and turnaround times. 

1. Optimized PA operations: RCM companies and their staff strictly adhere to standard operating procedures for their tasks. These procedures accommodate variances arising from health plan-specific guidelines and other requirements like Medicare benefits, thereby ensuring optimal procedural efficiency. 

Insider Tips to Complete Sleep Study PAs in 24 Hours 

Here are top six strategies for completing 100% authorizations within 24 hours.  

Sleep study prior authorization - Top six best practices: 

• Outsource sleep study prior authorization services to a trusted and compliant RCM company with proven expertise. 
• Assemble a dedicated pre-authorization team and provide consistent training and updates on guideline changes. 
• Invest in electronic Pre Authorization (ePA) systems to minimize errors and reduce turnaround times. 
• Conduct preemptive authorizations for pertinent procedures at the time of scheduling. 

• Integrate EHR with the ePA system to conveniently access all relevant documents and records when necessary. 
• Conduct monthly audits to optimize any prior authorization procedural inefficiencies. 

Inference 

Prior auth reforms are the need of the hour. But to wait for these reforms to take place so that PA hassles are manageable, won’t be wise. 

Sleep institutes should invest in PA operation optimization measures, and training on sleep study billing codes if they are unsure about outsourcing. Follow the best practices and understand the differences between how in-house teams and RCM companies handle insurance verifications. 

For more information, consider reaching out to Sunknowledge Services Inc., a HIPAA-compliant RCM company taking the burden of billing, coding, and prior authorizations off sleep study centers for almost two decades now.