- June 27, 2022
- Posted by: Steve Smith
- Category: Prior Authorization
Prior Authorization vs. Your Sanity
Of all the different steps that together go on to comprise medical billing, prior authorization is possibly the most time-consuming. It is a process that providers must complete to ensure that they receive the due reimbursement from their patients’ health insurance plans for services rendered. Prior authorization is essentially a payer’s requirement, introduced to ensure that unnecessary medical cost is not incurred during treatment and safe medication is prescribed. Without this formal approval, the patient’s health plan can choose to refuse to pay for the ‘goods’.
While all this is fine, it is the very process of obtaining prior authorization that can be a real pain for most providers. In spite of a growing prevalence of using electronic prior authorization, many providers still prefer doing it the old way, involving copious amount of paperwork, faxing and making telephone calls. Add to this the long hold-times that are usually associated with these calls and it is easy to understand why the process is such a tedious and taxing. In fact such are its extreme (and often, maddening) demands that prior auth, more often than not, leads to employee burnouts and people simply calling it quits.
Strategic Measures to Offload the Trouble
A recent survey has revealed that on an average, time spent on prior authorization in a week is equal to almost 2 business days. A typical prior auth request can take anywhere between 20 to 45 minutes to be completed. And when there are multiple requests to be completed, the strain on the back-office personnel can be tremendous.
In order to free up resources to engage them in more productive tasks, a large number of health care providers across the U.S. are choosing to outsource all their prior authorization work to specialized and dedicated, third-party agencies. Many of these billing experts are located offshore and work remotely on your account. The biggest advantage of such an arrangement is that providers can get all their prior auths completed at a nominal cost which is way lower than the salary of a regular, in-house medical billing staff.
Outsourcing also means that providers get specialized and dedicated attention to all their billing requirements. This results in an overall improvement and better streamlining of the revenue generation cycle. Collection rates go up, denials decline and operational costs get slashed by up to 80%! In short, if sustaining operations without burning a hole in the pocket is the real concern, no provider can really afford to overlook the many benefits of outsourcing.