Empowering PTs with Less Prior Authorization Burdens

Learn How to Avoid Prior Authorization Challenges

On August 15, 2023, there was a report about healthcare stakeholders being worried about the administrative hassle and how it's messing with patient care due to prior authorization.

And this is nowhere more apparent than in the PT industry. According to a survey conducted by the American Physical Therapy Association (APTA), administrative burdens significantly impact physical therapists' clinical outcomes and contribute to burnout.

Simplifying insurance claims for PTs can improve reimbursements, efficient workflows, and patient experiences.

Let's explore prior authorizations and how eliminating associated stressors empowers PTs.

• Challenges faced by PTs in insurance claims
• Enabling PTs with streamlined insurance claims
  
• Insurance companies that offer new prior authorizations
  

What is a Prior Authorization?

Prior authorization in physical therapy is obtaining approval from insurance companies before proceeding with specific therapy treatments or services. Physical therapists submit authorization requests to the patient's insurance provider, who then evaluates if the requested services meet the coverage criteria.

The goal is to prevent unnecessary treatments, reduce costs, and provide adequate care. However, it can lead to administrative burdens and care delays, causing frustrations.

Getting Prior Authorization for Physical Therapy

Need physical therapy but unsure about insurance approval? Here's how to obtain prior authorization:

1. Contact your patient's insurance company. Find the phone number on their insurance card.

2. Request a prior authorization form or number. The insurance company will likely tell you what information they need.

3. Gather required documents. This may include diagnosis code, treatment plan, and medical necessity documentation.

4. Submit the request. This can be done electronically or by faxing the completed form with supporting documents.

Be aware: Processing can take days or weeks. Consider using billing software that tracks authorization status to avoid scheduling delays.

Challenges Faced by PTs in Insurance Claims

As you can see from the definition above, prior authorizations are typically more complex processes.

Some challenges include:

Administrative Burden: Prior authorizations require physical therapists to go through a lengthy administrative process to gain approval from insurance companies before providing prescribed programs for their patients.

Time-consuming: Physical therapists have to wait for approval from insurance companies, which can result in treatment interruptions and potential setbacks in the patient's recovery.

Complex Requirements: Insurance companies have specific criteria and guidelines for physical therapists to obtain prior authorization. Requirements vary between providers, so if your PT clinic accepts multiple insurance providers, you may need more research to ensure exercise prescriptions comply.

Delays in patient care and treatment: The prior authorization process can cause delays in receiving necessary treatments and services, impacting the patient experience at your PT clinic.

Dealing with prior authorization hurdles can create inefficiencies in PT practice and strain patient relationships, potentially resulting in client loss. That's why it's crucial to simplify these procedures for PTs!

Enabling PTs with Streamlined Insurance Claims

Thankfully, insurance companies are lessening their requirements and implementing streamlining measures. This is good news for PTs as this will alleviate administration tasks and improve patient access.

But are there other ways to streamline this process?

Utilizing Technology for Automated Claims Processing

Utilizing technology for automated claims processing can significantly simplify the process for physical therapists (PTs). With the advancements in healthcare technology, automated claims processing systems can streamline the billing and reimbursement process, making it easier and more efficient for PTs.

Invest in a product that offers accurate payment collection for any payment model: in-network, hybrid, out-of-network, or cash-based/direct pay. (PtEverywhere can help with this!)

Reducing Admin Burden with Insurance with a Patient Engagement Platform

Ideally, look for a solution that allows you to handle all your operations and patient management effortlessly. The top-notch ones also provide convenient access to RCM and insurance billing.

PtEverywhere can help by:

• Checking eligibility online in real-time so PTs don’t waste time submitting claims that will be denied.
• Streamlining documentation and filing with electronic signatures.
• Integrating with EMRs to reduce errors and increase accuracy.
• Creating/scrubbing/submitting electronic claims.
• Reconcile ERAs for Medicare, Medicaid, and thousands of private insurance companies.

Furthermore, a patient engagement platform can bring meaningful value by integrating scheduling, messaging, and telehealth. 

Which Insurance Companies Offer New Prior Authorizations?

Insurance companies are finally starting to ease the burden of prior authorizations for physical therapists, with major players like UnitedHealthcare, Aetna, and Humana making significant changes. These adjustments are a step in the right direction, reducing administrative hassles and allowing PTs to focus more on patient care.

With the potential for more insurers to follow suit, the future looks bright for streamlining insurance claims in the PT industry. It's essential for therapists to stay informed and adapt to these evolving policies to ensure smoother operations and better outcomes for their patients.

United Healthcare Prior Authorization

UnitedHealthcare announced in March 2023 that it would eliminate nearly 20 percent of prior authorization requirements to simplify the healthcare experience. Starting September 1, commercial plans will see reductions in prior authorization for categories such as durable medical equipment, genetic testing, and cardiology. Similar reductions will apply to Medicare Advantage plans and individual exchange plans.

UnitedHealthcare also plans to implement a national Gold Card program in 2024, using an administrative notification process instead of prior authorization for most procedure codes. This program will apply to members across commercial, Medicare Advantage, and Medicaid plans.

Aetna

Aetna prior authorization eliminates pre-certification requirements for cataract surgeries and physical therapy in certain states. These changes align with the American Physical Therapy Association's advocacy to reduce excessive prior authorization use.

Humana

Humana recently eliminated its prior authorization requirement for cataract surgery in Georgia, effective August 1, 2023. This decision came after pushback from medical organizations, who praised Humana for removing barriers to timely surgery.

Prior Authorizations and PTs: A match not made in heaven

A study discovered that administrative tasks take up around 3% of the clinical time allocated, putting extra pressure on therapy department leaders and support staff outside the department. Showing time and time again how admin burden holds PTs back from running a sustainable practice.

Prior authorizations are one of these burdens that not only frustrate PTs but patients as well. They don't get the care they need for a successful recovery. Ultimately, prior authorizations harm everyone in PT healthcare.

It's great and exciting to see that some insurance companies are starting to reduce or even eliminate prior authorizations. But we still need a bigger shift in healthcare insurance companies. Hopefully, this recent trend will keep going in the future. In the meantime, consider teaming up with a platform that can make working with insurance companies easier to access. (We'd love to talk to you about it more!) 

To learn more about PtEverywhere, book a demo or check out our media center for more therapy tips and tricks!