Common Challenges in Hospital Prior Authorization

Close Encounters with Hospital Prior Authorization

In spite of major strides made in recent times to embrace in growing measures, technology-driven modern methods to speed up the process and make it more efficient, Prior Authorization remains one of the most dreaded parts of a typical medical billing process. The main reason for this is the continued insistence by a large number of providers and payers, on using a modus operandi that is heavily dependent on paperwork, sending faxes and making phone calls. This reason alone makes hospital Prior Authorization often assume Herculean proportions. Let’s take a closer look at the true state of affairs.

In the realm of hospital Prior Authorization, handling large volumes of requests is a usual phenomenon. The larger and busier the hospital, the more PA requests would typically be required to be handled on a regular basis. In the wake of the pandemic, as the job market continues to exhibit alarming signs of a rapidly proliferating shortage of skilled personnel, coupled with a proposed rise in minimum wages across the healthcare sector, it is becoming extremely difficult for employers to find competent workers or to sustain operations without incurring extra cost. When it comes to finding and recruiting trained, skilled and competent RCM (Revenue Cycle Management) professionals to handle say, a specialized task like hospital Prior Authorization, or recovering pending accounts receivable, hospitals are faced with many of the same constraints.

Alternative means to ensure better sustainability

Love it or hate it, hospital Prior Authorization is an area of work that one cannot afford to shun. After all, it is directly linked to the revenue of any healthcare practice. In the face of the current challenges faced in this area, a large number of providers across the U.S. are resorting to selective outsourcing of key back-office operational and administrative tasks to offshore partners, providing specialized support in areas such as billing, coding and managing other aspects of the revenue cycle.

It is a scenario where skilled and fully-trained Prior Authorization experts, albeit being located in remote locations and working at remarkably competitive rates, are dedicatedly providing support on a consistent basis with brilliant efficiency.

The advantages of such an arrangement are more than one. First, it allows hospitals to enjoy instant access to a ready pool of billing and coding professionals, without having to go through the usual rigmarole of finding, training and recruiting them – a proposition that has never been more difficult than now.

It also allows for huge cost savings as there is no overhead cost or employee benefits to be provided. Providers are required to pay only for the actual hours of work done. This naturally is allowing providers to sustain normal operations at the same cost as pre-pandemic times, and sometimes at an even lower expense, while keeping their regular, in-house staff members free to attend to other important aspects of their business.