Building a More Efficient Prior Authorization Process

Understanding Prior Authorization challenges

In the sphere of billing for healthcare services, Prior Authorization continues to be one of the peskiest affairs. Most healthcare providers are wary of the process and are often found to be extra worried about how to go about it without producing an adverse effect on their practice. The reason why Prior Authorization continues to alarm so many healthcare practices is the amount of time and effort that it entails. In spite of the introduction of electronic authorization methods, which promise to drastically reduce all the usual hassles associated with the process, Prior Authorization continues to be practiced using traditional means involving manual filling up of forms, plenty of paperwork and making long, tedious phone calls to the insurance company’s helpdesk.

It is a common sight across healthcare practices across the U.S. where the regular billing desk personnel are not able to manage the Prior Authorization pressure, and nurses and other medical personnel are brought in to alleviate it. This is an unfortunate situation where medical personnel are made to ignore actual patient care in favor of pursuing an essentially clerical task such as obtaining authorization for a prescription from an insurance company.

Building a More Efficient Process

It is evident that Prior Authorization can eat into a large part of your staff’s time and keep them from attending to more important matters. In a typical scenario, a practice that is more procedure-oriented (like surgery or GI), will be in greater need to have a full-time staff member to handle all prior auth tasks. This can place a significant financial burden on the practice. It can also put high stress on the personnel involved.

This is why many practices enlist dedicated, professional help from specialized third-party billing support providers. Through strategic outsourcing of Prior Authorization tasks to billing experts, providers can easily introduce better efficiency in their revenue generation process. Professional intervention can help bring down denial rates, increase approvals and get more PA requests completed in a day than before. This last advantage is something that busy practices can benefit from tremendously.

Simultaneously, with the aim to reduce undue stress on billing personnel, and also make the process faster and more accurate, e-authorization standards are being implemented in larger measures across the healthcare sector. Attaching proof of medical necessity is an important aspect of the entire process. In a conventional setup, the clinical information of a patient is in the HER and it needs to be extracted and sent with the request. It often happens, the information sent is insufficient, and a lengthy process of sending additional documents and missing information ensues, further delaying the process. E-authorization, on the other hand, eliminates many of these hassles.