How to Get Your Practice Ready to Meet Prior Authorization Demands

The A-B-C’s of Prior Authorization

Within the revenue cycle of healthcare practices, one of the most time-consuming processes is what is known as prior authorization. Also referred to as pre-authorization or pre-certification, the process essentially signifies obtaining a formal approval from the insurance payor that a specific, prescribed drug or treatment will be covered under the patient’s insurance plan.

While a heated debate continues to rage over the necessity for prior authorization and how it adversely impacts healthcare dissemination, one of the chief vices of the process is the time it generally takes. The pre authorization process, in its traditional and most commonly used form, involves sending patient information over fax, filling out and sending paper forms, and making multiple phone calls – all of which can run into many precious minutes for each prior authorization request.

Do We Need Prior Authorization?

It is easy to, therefore, why prior authorization is looked upon as a major contributing factor in delaying patient care. In many cases, as a recent study conducted by AMA (American Medical Association) has revealed, it leads to critical delays in receiving treatment, and sometimes, even treatment abandonment because patients refused to wait any longer to get a prior auth request approved.

All said and done, prior authorization, let’s face it, will stay with us for some time. Till a clear verdict is reached about whether it is necessary for keeping medical expenses under control, or if it is just an unnecessary burden on medical practices, pre authorization will continue to play an important role in the revenue cycle of healthcare providers.

Ways to Get Even

In view of this, and to keep internal costs down and free up resources so that more time can be spent on actual patient care than on sending and managing pre authorization requests, a large number of healthcare practices are engaging dedicated, third-party agencies to take the burden off their shoulders. It pays off in more ways than one. These agencies use experienced and well-trained personnel to manage prior auth requests on behalf of their clients, and the results are often a reduced rate of denials, a greater number of prior auth requests handled in unit time and an overall increase in collections at a lower operational cost. In short, outsourcing prior authorization tasks to a dedicated service provider is an option that busy healthcare practices cannot afford to overlook.