Making Prior Authorization Work for You

The Dual Nature of Prior Authorization

The very mention of prior authorization is sure to elicit a mixed response. There is a school of thought, mostly backed by insurance companies, that it is an absolute requirement for ensuring that health care costs are not unnecessarily inflated and patients receive safe and proper medical service. However, there is another group of people, mostly comprising actual health care practitioners, who claim that prior authorization is a completely unnecessary and redundant intervention, delaying treatment and causing much hassle for both the patient and the doctor.

Whatever the truth is, prior authorization remains something that we are not yet ready to shake off. It may be looked upon as a necessary evil, or a boon in disguise. But all that is beyond the scope of this piece of writing. What we ought to consider is the fact that prior authorization (which, by the way, has a handful of other monikers such as ‘preauthorization’, ‘pre-certification’ or simply ‘prior auth’ in short) is infamous for being an extremely time-intensive process. In fact a recent study has shown that on an average, a practice spends about 2 business days’ worth of time in prior auth in a week.

Escaping the Prior Auth Death maze

In a bid to escape the strain that prior auth processes put on billing personnel, coupled with the amount of time that is usually spent for them, a growing number of health care providers are outsourcing them to specialized, third party agencies. These organizations are fully equipped to take care of all prior authorization tasks at a cost that is remarkably lower than what it would have cost to get the same tasks done by a regular, in-house team.

The benefits of strategic, offshore outsourcing do not just stop here. Engaging prior auth experts also translate to reduced denials, more collections and a more streamlined revenue generation process. Providers find more time for themselves and their resources can now be free to pursue more important tasks, such as engaging in actual patient care or expanding the existing business. And quite frankly, these are the kind of prospects that will excite any health care practice willing to move up to the next level of success and profitability.