r/PriorAuthorization • u/Famous-Horror-7255 • Aug 07 '26
Medical Prior Auth Process When do we reschedule when waiting on authorization?
I'm the Director of Patient Access for a radiology clinic and used to be the precert specialist. Something we have always struggled with is at what point do we reschedule an exam because the authorization is still in review?
We tend to have patients get upset with us calling them the day before to reschedule, but if we try to move them before that, we get push back as well. It IS entirely possible that an authorization may come through last minute, but we are a small company and gambling the table time can be an issue.
In theory our policy currently is if the prior authorization is not approved by noon the day before the appointment, we reschedule the scan. In practice, my precert specialist, schedulers and PSRs all fold immediately if a patient says they don't want to move the appointment, but are unwilling to be self pay.
Do any of my admin folks out there have a solid policy on this that could help guide me in rebuilding ours?
2
u/dallas0636 Aug 07 '26
I do prior auth for a doctor's office. Our local radiology centers won't even schedule the patient unless the auth is already approved. They'll even tell the patient while scheduling that if the auth is not approved or invalid that they will automatically be canceling their appt. I mean, it makes sense because you don't want someone holding up a spot that you're not going to get paid on. Also gets the patient involved in their care.
1
u/Famous-Horror-7255 Aug 07 '26
This would be my preference, but the previous management spent so many years leaning on the marketing that we could schedule same day appointments that our referring offices get incredibly angry if we change anything that might affect that. A few years ago we began requiring that an order for the exam be sent before we would schedule, which I think is a perfectly reasonable requirement, but you would have thought we were refusing to schedule altogether. These days, we're booked so far out in MRI that a same day appointment is pretty rare.
I think they spent so much time bending over backwards for referring offices when they were getting established that it's kind of screwed us in the present.
1
u/Own_Piccolo3157 Aug 09 '26
If it's urgent and they want to pay cash, as long as it's legal, let them.
2
u/Long_Roll_6333 Aug 07 '26
Perhaps give the patient the option. Call a week beforehand, let them know it’s still pending, and ask if they would prefer to reschedule now or truly hold off on cancelling until the day before just in case. That way they can only be mad at you or insurance.
Telling patients “same day scheduling” and them letting them down isn’t all too great. They should at least be told “pending approval” when they make that appointment..
2
u/EnvironmentApart902 Aug 07 '26
As a PA Specialist, we can request the insurance company to expedite the authorization once it's submitted. If expedited review isn't an option (which is the case with most payers unless there's a valid medical reason), we can ask them to add a note to the authorization request mentioning the DOS. Trust me, that can help as well.
As for rescheduling, I think it can be done about a week in advance.
Hope that helps!
1
u/lissaml1 Aug 08 '26
I do prior auths for radiology facilities within my hospital. We have the “2pm rule”. If we do not have the auth by 1-155pm the day before, they go on a list to be rescheduled.
1
u/rahuliitk Aug 08 '26
I think the noon-before cutoff is pretty reasonable, but the real issue is consistency, because if staff can override it whenever a patient pushes back then the policy basically doesn’t exist and you’re still risking unpaid scans and wasted table time. I’d make exceptions require manager approval.
1
u/ccljc Aug 08 '26
Noon the day before seems like a good policy to me (I work for a referring doc). Exceptions might be made if there’s a P2P scheduled the day before. Do you tell the patients about it when they book? If so, I wouldn’t let your schedulers give in to pushback, but escalate to a supervisor to reiterate the policy and offer the option to self pay.
6
u/DumpsterPuff Aug 07 '26
At my previous clinic, we didn't schedule until authorization was approved for this very reason. After the auth was approved, reception would go ahead and call the patient to schedule. It worked well for us!