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The 10 Most Common Authorization Mistakes Clinics Make — And How to Fix Them Fast

Authorizations are one of the biggest revenue blockers in healthcare.
When your authorization workflow breaks, your entire billing cycle collapses — claims deny, money gets stuck, and the clinic loses thousands.

Most practices think denials happen in billing.
Reality: authorization errors at the front end cause 70% of preventable claim failures.

Here are the 10 most damaging authorization mistakes clinics make and exactly how to fix them.

1. Not Verifying If Authorization Is Required for the Specific CPT Code

Many clinics assume:

“If the patient has coverage, everything is approved.”

Wrong.

Authorizations are CPT-code specific, not insurance-policy specific.

Common examples:

PT eval allowed — but 97110 or 97530 requires auth
Psychotherapy allowed — but 90837 requires auth
ABA codes approved — but parent training not approved

📌 Fix:
Always verify permission per CPT, not per visit.

2. Starting Treatment Before Authorization Is Approved

The fastest way to a denial.

Some clinics:

Submit the auth late
Start therapy early
“Assume” approval will come

Payers don’t care — if auth isn’t active on the date of service, the claim will deny.

📌 Fix:
No auth = no treatment.
Use a hard block in scheduling.

3. Wrong Diagnosis Code on the Authorization

If the diagnosis code on the PA doesn’t match the claim, denial is guaranteed.

Frequent mismatch cases:

Behavioral health ICD changes
PT patient shifts from injury to chronic pain
Neuro/rehab codes updated mid-treatment

📌 Fix:
Confirm ICD-10 matches the approved diagnosis before submitting the claim.

4. Expired Authorization (Clinics Don’t Track Dates)

Most authorizations expire in 30, 60, or 90 days — or after a fixed number of visits.

Common errors:

Using expired auth
Using future-start auth (not active yet)
Missing the last covered visit

📌 Fix:
Use an authorization tracker with:

Start date
End date
Units/visits allowed
Units remaining

5. Wrong Number of Units/Visits Requested

Clinics often request:

Too few units
Wrong units per CPT
Wrong frequency limits

Then halfway through treatment, no units are left.

📌 Fix:
Always request:

The right CPT combination
Higher units for long-term cases
Extra visits buffer when medically justified

6. Authorization Not Attached to the Correct Provider

A very common mistake.

Auth must match:

Rendering provider NPI
Supervising provider (if required)
Location taxonomy

If not, the claim denies.

📌 Fix:
Before submitting an auth:

Confirm the rendering provider is credentialed
Match NPI, taxonomy, clinic location

7. Not Updating the Authorization When Treatment Plan Changes

If the CPT codes change but the PA stays the same, the payer rejects claims.

Example:

Started with 97110 and 97112
Clinic adds manual therapy (97140)
But 97140 is not approved

📌 Fix:
Any treatment-plan change = update the authorization.

8. Incorrect Documentation Submitted for Authorization

Some payers require:

Medical notes
Progress summary
Evaluation report
Treatment plan

Missing or vague documentation = PA denied.

📌 Fix:
Submit clear, skilled documentation with all required elements.

9. Delayed Authorization Follow-Up

Many clinics:

Submit auth
Don’t follow up
Assume payer will approve

Payers lose faxes, mis-route requests, or delay processing.

📌 Fix:
Follow up every:

48 hours for standard requests
24 hours for urgent cases

Use a call log to document interactions.

10. Storing Authorizations in Emails, Staff Phones, or Random Folders

This is operational chaos.

When the billing team can’t find the auth:

Claim gets submitted wrong
Denial happens
AR backlog increases

📌 Fix:
Use a centralized authorization folder inside your EHR or shared drive with:

PDF of approval
Units
Dates
CPT codes approved

How to Build a Clean Authorization Workflow (Fast Fix)

A high-performing clinic uses a tight authorization process:

✔ Daily VOB + auth check

✔ CPT-specific authorization verification

✔ Real-time auth tracker

✔ Hard scheduling block for non-approved visits

✔ Provider-to-billing communication loop

✔ Weekly audit of expiring authorizations

✔ Monthly review of payer-specific rules

This eliminates 80% of authorization-related denials.

Final Takeaway

Authorization mistakes don’t just cause denials — they destroy cash flow.

When your clinic fixes:

Wrong CPT approvals
Expired authorizations
Missing documentation
Wrong provider details
Poor follow-up

…your denial rate drops fast, AR clears up, and revenue stabilizes.

This is one of the easiest, highest-impact improvements clinics can make.