How to Stop Struggling with Prior Authorization

Even with the growing acceptance of its electronic variant, prior authorization continues to be done in the traditional paper-fax-telephone mode in very large measures across the US. A national debate continues to rage about the need for prior authorization, as warranted by various insurers. Federal laws are continually being framed to lessen the burden on physicians and healthcare practices. But in spite of all such initiatives, prior auth continues to eat into the precious time of caregivers that could have been spent otherwise in providing actual services to patients.

A recent survey conducted by American Medical Association (AMA) has unearthed some alarming facts about preauthorization. It has been discovered that physicians and their staff spend an average of almost two business days (13 hours) each week to complete an average of 41 prior authorization requests! The rigorous and time-consuming demands of prior auth also adversely impacts patients, with 93% of physicians reporting that the process delays in providing patient care, and 82% confessing that it has caused patients to abandon treatment due to persistent struggles with health plans/insurers over getting a prescribed medication or treatment authorized for coverage.

The California Medical Association (CMA) is currently sponsoring a legislation that requires health plans to exempt physicians from prior authorization requirements if they have practiced within the plan’s criteria 80% of the time. But such interventions are very few in number, and prior auth continues to make its presence felt on the overall productivity and profitability of healthcare practices.

A viable way to alleviate the difficulties is to engage dedicated, third-party prior authorization services. Most of these services have highly trained personnel who are fully aware of the specific prior auth requirements by various payors and are highly experienced in dealing with them. As a result, they can bring about a noticeable increase in the prior auth approval rate, reduce denials and increase overall collections for the practice. Dedicated prior authorization service providers can be a real boon for busy healthcare practices as they help in freeing up resources, reduce operational costs and generate more collections at the end of the day.