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Dan Murdoch

November 1, 2023
Prior Authorization
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Prior Authorization Challenges Facing Physical Therapy Practices

Prior Authorization Challenges Facing Physical Therapy Practices

Physical therapy practices and medical practices with physical therapy treatments have two primary goals:

  1. Optimized patient outcomes.
  2. Turning a profit for a robust, thriving practice to continue providing optimal care.

These two objectives are symbiotic in their own way. 

Optimizing patient outcomes often means less time for the many administrative duties within healthcare. On the other hand, a steady flow of revenue typically means you’ll have the resources to continue providing optimal care.

However, these two goals can clash. Specifically, the administrative measures required to remain a profitable business–like revenue cycle management–can hinder your ability to provide the quality of care you aspire to.

Moreover, the administrative requirements can make you less profitable than you could be if you could focus on your patient’s needs instead of letting dotted i’s and crossed t’s monopolize your attention.

Prior authorization is a critical component of revenue cycle management, and–as we’ve already broached–it’s rife with challenges that impede productivity, efficiency, and profitability.

Prior Authorization In Physical Therapy: A Brief Overview

Before proceeding with treatments and services, your physical therapy practice must gain approval from insurance companies. The insurance provider evaluates whether the services requested meet coverage criteria after you or your team submit authorization requests.

While prior authorization is crucial for reducing costs, preventing unnecessary treatments, and providing quality care, it can lead to care delays and administrative burdens. 

Those burdens can hamper your physical therapy practice’s growth, momentum, and quality of care. Below, we’ll examine some of the related challenges:

Delving Into The Administrative Burdens Of Prior Authorization

The administrative process involved with physical therapy prior authorizations can be time-consuming. Insurance companies don’t make it simple, and the amount of time it can take to gain approval can cause significant delays in providing prescribed treatments to patients. 

How Prior Authorization Inefficiencies Hurt Your Physical Therapy Practice?

Physicians and other employees at medical practices spend 14.6 hours per week on prior authorizations, adding up to approximately $85,000 spent supporting a physician. While this isn’t exactly the same as physical therapy, the processes are similar enough to shed light on your clinic or practice’s issues.

Unfortunately, this isn’t all productive time–nurses and other front office staff might spend 45 minutes on hold dealing with prior authorization only to learn that one wasn’t necessary. 

Furthermore, since most insurance plans have highly specified prior authorization requirements–with minimal overlap–practices struggle to navigate and streamline. Physical Therapists and staff must allocate time toward research on each insurance provider’s specifications to ensure everything is above board.

Thus, it’s unsurprising to hear that 92% of surveyed physicians report care delays due to prior authorization procurement challenges.

What’s worse? Almost 80% of survey respondents said delayed authorizations cause patients to abandon care.

When you lose patients, the damage is multi-pronged. Your reputation and bottom line suffer for it, and people left untreated are stuck with potentially debilitating conditions.

Overcoming Prior Authorization Challenges At Your Physical Therapy Clinic

There’s no need to remain saddled with inefficient, time-consuming, and patient-repelling prior authorization processes at your physical therapy practice–not when a tool like Adonis is available.

Adonis’s technology utilizes deep learning and analytics  to simplify the entire prior authorization process. 

Our cutting-edge technology quickly checks for upcoming patient visits requiring a prior authorization, and flags any processing  issues or delays. Its centralized access to critical front-end revenue cycle data enables physical therapy providers and their administrative teams to minimize delays to care and streamline workflows. 

With Adonis, denials and payment delays won’t impede your ability to provide optimal care because our Prior Authorization solution helps identify covered procedures beforehand.

Learn more about how Adonis can help enhance and streamline your practice’s revenue cycle management processes by requesting a demo today.

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