5 Innovative Ways to Tackle PA Challenges in Oncology Billing

Prior authorization plays a critical role in your oncology billing practice. PA process requires you to obtain approval for providing certain oncology treatments, procedures, and prescriptions. PA not only ensures that oncology requirements are properly met but also efficiently manages costs.

Unfortunately, most oncology practices often fail to receive PA approvals as every insurance company has its own set of complex PA rules. Additionally, insurance companies are increasing the list of cancer treatments and drugs requiring PA. Failure to obtain PA approvals not only causes claim rejections but also becomes the reason for out-of-pocket expenses for your patients. Fortunately, you can still navigate the complex maze of PA in the oncology billing process by following the strategies mentioned below-

5 Strategies to improve PA in the oncology billing process:

1) Clearly understand insurance policies:

To avoid any potential mistake in PA management, you must thoroughly understand insurance policies and respective guidelines. Also, you need to remain on top of the recent changes and requirements set by federal and private insurance companies. Train your internal PA team on different PA request forms, documentation processes and submission formalities.

2) Collect complete patient information:

Collecting detailed and accurate information is paramount for successfully receiving PA approvals from patients’ insurance companies. You must verify patient information diligently to avoid errors. You should verify critical information like patient demographics, insurance coverage details, and medical records. Also, do not forget to document critical information such as medical notes, test results and treatment plans.

3) Maintain a healthy communication:

To avoid any doubt and receive payments faster, you should proactively communicate with a patient’s insurance company. Also, have transparent communication with your patients to ensure that they are well informed about the PA process, thus reducing the chances of confusion and frustration.

4) Track and follow up on PA requests regularly:

Keep your PA process efficient with strong tracking and follow-up systems. Use a centralized database to monitor each PA request and ensure timely follow-ups.

5) Leverage an electronic prior authorization (ePA) platform:

If you are still using a manual PA process, you are falling behind. Switching to electronic PA (ePA) platforms can simplify and improve your PA process in oncology billing.

Oncology services often struggle with getting prior authorization (PA) approvals. To simplify this process, many practices turn to professional billing companies, allowing their staff to focus on patient care while their billing partner handles PA and other administrative tasks.

For reliable PA services, consider Sunknowledge. Their experts manage the entire PA process, including timely requests and follow-ups. Recently, Sunknowledge secured PA approval for the costly chemotherapy drug Pembrolizumab (Keytruda) for a renowned oncology practice—a feat most oncology billing companies fail to achieve.

To learn more about Sunknowledge’s oncology billing and PA process, talk to one of their RCM experts today!