{"id":125828,"date":"2021-10-19T16:00:05","date_gmt":"2021-10-19T21:00:05","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=125828"},"modified":"2026-02-24T07:20:58","modified_gmt":"2026-02-24T12:20:58","slug":"how-do-authorization-denials-drive-costs-in-healthcare","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/how-do-authorization-denials-drive-costs-in-healthcare\/","title":{"rendered":"Healthcare costs increase by authorization denials &#8211; Here&#8217;s why?"},"content":{"rendered":"<section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\">[vc_empty_space]<div class=\"text-block \" ><div class=\"simple-text \"><h2 style=\"font-family: Roboto;font-weight: 400;font-style: normal;font-size: 36px\"><span style=\"color: #ff6600\"><strong>Healthcare costs increase by authorization denials<\/strong><\/span><\/h2>\n<p><span style=\"font-weight: 400\">A study conducted by Health Affairs revealed that <a href=\"https:\/\/www.billingparadise.com\/independent-practices\/\">Independent practices<\/a> and <a href=\"https:\/\/www.billingparadise.com\/hospital\/\">Hospitals<\/a> spend an average of $68,274 per year for contacting health insurance. In many cases, Prior authorization appeals are a time-consuming process. Few Insurance companies have options for retro authorization When the patient is in need of medication\/Treatment and prior auth is delayed or not obtained on time, it might become a real impact on the patients. Many doctors report that Authorization denial is detrimental to patient care and it affects reputation. <\/span><\/p>\n<\/div><\/div>[vc_single_image image=&#8221;125830&#8243; img_size=&#8221;full&#8221; alignment=&#8221;center&#8221;]<\/div><\/div><\/section><section  class=\"section no\"><div class=\"row\"><div class=\"wpb_column col-md-12 have-padding\"><div class=\"text-block \" ><div class=\"simple-text \"><p><span style=\"font-weight: 400\">And the data shows that administrative cost for prior authorization is significantly high compared to other tasks like claim submission and eligibility verification. And also it indicates that 35% of the revenue lost in the process are due to authorization denials. Some of the common reasons for authorization denials\u00a0<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\">Missing prior authorization number in the claim form<\/span><\/li>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\">Authorization is invalid for the service date\/procedure code billed<\/span><\/li>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\">Limits exhausted in the authorization<\/span><\/li>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\">Insufficient documents for obtaining authorization<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">A health system in Texas outlined their issues with prior authorizations and claim denials in a recent round table discussion. The company executive stated \u201cthey had an efficient process a few years ago but now with all the payers\u2019 changes, what was once effective is no longer effective for denial prevention. However, in discussions with payers, they indicate the goal is not to create hassles but to promote efficacy and patient safety. Also, the payer industry claims to hold down costs for the healthcare system\u201d<\/span><\/p>\n<h4 style=\"font-family: Roboto;font-weight: 400;font-style: normal;font-size: 24px\"><strong>Steps to reduce authorization denials<\/strong><\/h4>\n<p><span style=\"font-weight: 400\">It may not be possible to completely eliminate the prior authorization denials. But by keeping checkpoints and best practices we can bring it under control. Here are some of the ways to reduce the authorization denials for your practice and hospitals.<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\"><a href=\"https:\/\/www.billingparadise.com\/specialties\/orthopedic\/appointment-scheduling.html\">Having a structured pre-registration team<\/a>.<\/span><\/li>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\">Training staff regularly on the insurance guidelines.<\/span><\/li>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\">Creating a centralized system for effective follow-ups.<\/span><\/li>\n<li style=\"font-weight: 400;color: #515151\"><span style=\"font-weight: 400\">Documenting the process thoroughly, so that it can be used for appeals<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>[vc_raw_html]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[\/vc_raw_html][vc_raw_js]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[\/vc_raw_js]<\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"[vc_empty_space]Healthcare costs increase by authorization denials A study conducted by Health Affairs revealed that Independent practices and Hospitals spend an average of $68,274 per year for contacting health insurance. In many cases, Prior authorization appeals are a time-consuming process. Few Insurance companies have options for retro authorization When the patient is in need of medication\/Treatment [...]","protected":false},"author":2,"featured_media":445315,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[721],"tags":[],"class_list":["post-125828","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-collections"],"_links":{"self":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/125828","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/comments?post=125828"}],"version-history":[{"count":8,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/125828\/revisions"}],"predecessor-version":[{"id":449862,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/125828\/revisions\/449862"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media\/445315"}],"wp:attachment":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media?parent=125828"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/categories?post=125828"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/tags?post=125828"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}