How to Build a Better Prior Authorization Process

Learning to Live with Prior Authorization

An important quality and cost-controlling measure implemented by insurance payors in the US, prior authorization is also something of a burden for most healthcare practices. A number of recent studies, time and again, have shown how prior authorization (or ‘preauthorization’, or ‘precertification’, as it is often referred to) consumes time for those engaged in its pursuit, time that could have been spent in actual patient care or other more productive efforts.

Love it or hate it, prior authorization is a process that is not easy to shake off. After all, the collections from your practice are directly linked to it. Miss out on this little but critical step of your billing process, and you could end up getting denied of your dues from the insurance payor. This is all the more relevant if you are in the business of prescribing DME (Durable Medical Equipment) to your patients where the onus of proving the medical necessity of the prescribed items is even stronger.

Add to all such formalities the fact that an average prior authorization process could take anywhere up to 30 – 40 minutes (including making phone calls to the insurance company and finally reaching the right person on the other end, the countless seconds the caller is kept on hold, faxing in all the required documents along with the prior auth form et al) – and you can easily realize why prior auth is so often considered nothing short of a sheer nightmare for most providers.

A Better Way To Mitigate Challenges

The answer lies in strategic offshore outsourcing to dedicated specialists. When the domestic market is rife with problems (rise in cost, labor shortage, inflation, etc.), the best option is to look for offshore service providers who can deliver at a lower cost. This is why a rapidly growing number of service providers are opting for outsourced billing and coding services from reputed offshore agencies.

The advantages are many. First, there is an instant reduction in operational cost. No more worries about finding and recruiting skilled billing professionals. You can now get immediate access to a vast pool of fully-trained resources to start working for you at a highly competitive hourly rate. In most cases, providers also experience a sharp increase in the efficiency of the overall billing process, along with a significant increase in collections. The rate of claim denials also drops.

So if prior authorization has been affecting your overall productivity, it’s time you seriously considered outsourcing the process to dedicated, third-party experts. The stakes are too high of recruiting, training and maintaining an in-house team. Free up your resources, bring down your billing cost and move ahead with your practice with the help of a strategic billing partnership.