Common prior authorization issues in podiatry slow down care and drain your resources. But when you know what traps to avoid, you can speed things up and get back to healing feet.
In this blog, we break down common prior authorization issues in podiatry and show clear ways to avoid them.
What Is Prior Authorization?
Prior authorization means getting the approval from insurance before you provide certain treatments or services. The insurer wants to make sure the care is needed and follows their rules.
Why Does It Matter?
For podiatry practices, this creates a bottleneck. You need approval before ordering an MRI for an ankle injury or prescribing custom orthotics. This means you’ll deal with paperwork, phone calls, and waiting.
When prior authorization gets delayed or denied, patients suffer. Their pain lingers, and their condition gets worse. This will lead to your practice losing revenue while staff spend hours chasing approvals.
To prevent yourself from revenue loss, consult our podiatry services.
The Most Common Prior Authorization Problems
Missing or Wrong Information
Insurance companies are picky about details. Any missing letter in a diagnosis code can trigger a denial.
- Wrong patient info
- Incomplete medical records
- Vague treatment descriptions all cause problems
Many podiatry prior authorization requests fail because the paperwork lacks clinical justification.
Unclear Medical Necessity
Many practices stumble here. The insurance company needs proof that your treatment is medically necessary, not just helpful or preferred.
For example, you treat a patient with severe plantar fasciitis, needs custom orthotics. If your notes don’t show that conservative treatments failed first, the claim will be denied. Document every step:
- The detailed explanation of the denial reason.
- Physical therapy attempts
- Injection trials
- The reasons for considering custom devices next
Using Old Guidelines
Insurance policies change constantly. What worked last year might not fly today. Many prior authorization issues in podiatry stem from using outdated criteria or forms. If your team doesn’t stay current, you’ll face repeated denials.
Wrong Procedure Codes
Medical coding in podiatry can be tricky. Similar procedures have different codes, and picking the wrong one guarantees a denial.
Bunion surgery, for instance, has multiple CPT codes depending on the technique used. Billing for the wrong code not only delays authorization but can also raise red flags for your practice.
Incomplete Patient History
Insurers want the full story. They need to see what treatments you’ve already tried and why they didn’t work. When your prior auth request jumps straight to advanced care without showing the journey, expect pushback. E.g., in the treatment of wound care of diabetic patients, you must document
- Wound measurements
- Infection status
- Vascular assessments
- All previous treatments
Anything less invites denial.
How These Issues Hurt Your Practice
Time is money, especially in healthcare. When your staff spends hours on prior authorization tasks, they can’t focus on patient care. Delayed approvals lead to delayed treatments and payments. Your cash flow suffers while you wait for insurance decisions. Patient satisfaction also drops. People don’t understand why they can’t get care when their doctor says they need it. They feel frustrated and sometimes blame your practice instead of the insurance company.
Some patients give up when the auth process takes too long. They skip important treatments, which can lead to worse outcomes. This also raises potential liability issues for your practice.
Smart Strategies to Fix Prior Auth Issues
Build Better Documentation Habits
Strong clinical notes are your best defense against denials. Create templates that prompt providers to include all the details insurers typically request.
Train Your Team Well
Your front office and billing staff need ongoing training about prior authorization requirements. They should know which services need approval and how to spot potential problems before submission.
Use Technology Wisely
Modern practice management systems can automate parts of the prior auth workflow. Some electronic health record systems integrate with insurance portals, making it easier to submit requests.
Verify Coverage Early
Don’t wait until the day of service to check if something needs prior authorization. Verify coverage when scheduling appointments.
Appeal Denials Quickly
When an authorization gets denied, don’t just accept it. Review the denial reason carefully and respond promptly with additional information.
Build Relationships with Payers
Get to know the case managers and medical directors at major insurance companies. Some insurers have hotlines or reps to help you.
Conclusion
Common prior authorization issues in podiatry don’t have to control your practice. Yes, the process is frustrating and takes time. But with the right systems and strategies, you can reduce all the common errors.
If managing prior authorizations and medical billing is too much for your podiatry practice. Contact Billing Podiatry now. We can simplify your revenue cycle and solve your prior authorization issues for good. We help healthcare providers manage insurance authorizations and claims. Our strategies cut down on denials. This lets you focus on what matters most: providing excellent patient care.
FAQs
What are common reasons for prior authorization denials?
According to the general consensus, some of the most common prior authorization denial reasons include:
- Incomplete or Incorrect Information.
- Lack of Prior Authorization Request.
- Administrative Errors.
- Duplicate Requests.
- Out-of-Network Provider.
- Plan Coverage Limits.
What is the new CMS rule on prior authorization?
CMS’s new prior authorization (PA) rules (CMS-0057-F), effective largely by 2026/2027, aim to speed up approvals, improve transparency, and cut burdens via digital tools (FHIR APIs) for Medicare Advantage (MA), Medicaid, and Marketplace plans.
What to do if insurance denies prior authorization?
If your prior authorization is denied, first get the denial letter to understand why, then work with your doctor to appeal by providing more medical info, requesting a peer-to-peer review, or exploring alternative treatments/medications, and if needed, escalate to a formal internal or external appeal with your insurer.