Prior Authorization: How to Win the Insurance Battle Without Losing Your Mind

At the Masterclasses in Dermatology APP Institute, Victor Czerkasij, DNP, DCNP, FNP-C, CWCP, MA, MSN, delivered a refreshingly candid session titled “Prior Authorizations: Tips and Tricks.” With humor, clarity, and a deep understanding of real-world frustrations, he tackled one of the most time-consuming tasks facing APPs today.

“Step therapy: Also known as ‘fail first,’ ‘purgatory,’ or the ‘walk of shame,’” Dr Czerkasij said, drawing laughs and nods of recognition from the audience.

In a system that promises to reduce costs but often delays care and wears down patients and providers alike, prior authorizations have become a modern headache. And as Dr Czerkasij reminded attendees, there is no ICD-10 code for the hours spent fixing it. “ICD-10: LOZR 24.7,” he quipped, referring to loser.

Dr Czerkasij emphasized the importance of building strong relationships with specialty pharmacies and pharmacy benefit managers. He encouraged attendees to “conduct an interview” with their partners and ask critical questions about benefit investigation, coverage coordination, and co-pay assistance.

The second half of the session focused on managing denials and writing effective appeals. Dr Czerkasij encouraged providers to leverage artificial intelligence tools to draft letters of medical necessity, exceptions, or appeals, and to not overlook the power of a strong peer-to-peer conversation.

“Be nice. Really,” he said. “Express appreciation and review the journey for both patient and provider.”

He also provided a reminder that documentation matters: Include the correct ICD-10 codes, treatment history, comorbidities, lab values, and how the condition impacts a patient’s life and work.

Reference

Czerkasij V. Prior authorizations: tips and tricks. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.