The Administrative Burden of Authorizations
Prior authorization remains one of the largest sources of administrative burden and revenue risk within the revenue cycle. Payer specific rules and documentation standards vary widely and change frequently. Failure to obtain authorization or to meet authorization conditions leads directly to denials that are difficult or impossible to overturn. The Centers for Medicare and Medicaid Services has finalized rules to address the prior authorization process and improve efficiency.
A Specialized Workflow for Success
Effective RCM organizations treat authorization management as a distinct and specialized workflow rather than an ad hoc task. Clear ownership ensures accountability while centralized payer rules intelligence reduces variation across the practice. Defined escalation paths prevent stalled requests from delaying care or payment. Over time disciplined authorization processes reduce denial rates and improve predictability for both patients and providers.
Key Components of a Modern Authorization Process
A high performing authorization workflow follows a structured sequence to ensure revenue integrity.
- Service Identification: Identifying services requiring authorization based on specific payer rules.
- Documentation Collection: Gathering all necessary clinical documentation to support the request.
- Submission and Tracking: Submitting requests and monitoring status to prevent delays.
- Claim Linkage: Confirming approval and linking the authorization number to the claim.
The Impact on Denial Management
When authorization processes are weak they become a leading cause of back end denials. Because these denials often result in permanent revenue loss when medical necessity cannot be substantiated retroactively they require proactive prevention. Treating authorization as a system signal allows organizations to redesign workflows and reduce future denial volume.
How Harris CareTracker Supports Authorization Management
Harris CareTracker is an integrated operational system that provides the tools needed to manage complex authorization requirements.
- Tracking and Documentation: The platform supports authorization tracking and documentation linkage to improve accountability.
- Avoidable Denial Reduction: By identifying potential issues earlier in the process the system reduces the likelihood of authorization related denials.
- Consistent Rules Engine: An advanced billing rules engine applies payer and policy logic consistently to help staff focus on exceptions.
- Real Time Visibility: Practices gain clear visibility into claim status throughout adjudication to ensure authorizations are properly applied.
