- August 18, 2023
- Posted by: David Smith
- Category: Gastroenterology Prior Authorization
Prior authorization is an important step that most patients have to take care of, before being able to access necessary medical care. As more and more medications and critical medical procedures require prior auth, not just busy and complex specialties like gastroenterology, but also other fields of medicine including dermatology and pediatrics, are feeling the need for PA specialists to cut-down on waiting time for authorization, reduce documentation errors and operational costs.
A report by the American College of Gastroenterology published in 2022, found that “prior auth requirements have gone up by 250% over the last 10 years, with the number of GI procedures requiring authorization increasing from 10% in 2012 to 35% in 2022”.
Although the “number of young American adults being diagnosed with GI disorders every year is about 60-70 million”, according to the American Gastroenterological Association’s (AGA) ‘Trust Your Gut’ campaign, growing utilization management requirements have increased the administrative workload for non-clinical staff at healthcare facilities to such an extent that it is leading to errors and delays without revenues growing at the same pace as patient volume.
Common gastroenterology procedures that require prior authorization
PA requirements may vary for each health plan. Insurers generally ask for prior authorization for procedures that are elective, non-emergency, or high cost/risk. A list of common gastroenterology procedures that require authorization is given below:
- Esophagogastroduodenoscopy (EGD)
- Capsule endoscopy
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Percutaneous endoscopic gastrostomy (PEG) tube placement
- Bariatric surgery
- Hiatal hernia repair
- Cholecystectomy (gallbladder removal)
- Pancreatic surgery
The procedures mentioned above are diagnostic/ therapeutic in nature – any delays in securing authorization for these procedures can have serious negative impacts on the patients’ health.
Value-addition by gastroenterology-specific prior authorization specialists
A professional prior auth services company relies on the services of its in-house prior authorization specialists, who are experienced and trained in completing authorization requests on time. By leveraging automation tools, sound payer relations and effective channels of communication, these professionals are able to secure 97% of all pre-authorizations in 24 hours.
Let’s look at a few achievements that our PA specialists are proud of, and our clients can’t seem to get enough of:
- Pre auth requests submitted on the same day – 100%
- Prior authorization secured on the same day – 97%
- Average number of prior auth secured by a PA specialist – 3 PAs/hour
- Reduction in operational costs by 70%
- Excellent communication and reporting standards
- One of the best productivity metrics in the industry
- Unparalleled prior auth support and answering services
- Value-addition through services like re-authorization and doctor’s office follow-up
For more information about our expertise in securing prior authorization for gastroenterology procedures and specialty medications, or to know more about our client references, and flexible, volume-based pricing models, please contact Sunknowledge Services Inc., a reputed healthcare RCM company, helping healthcare providers to reduce costs, maximize revenue and drive operational efficiencies.