Staying Sane Amidst the Prior Authorization Madness

Prior Authorization: The Bane of Medical Billing?

Ask any medical practice in the US about prior authorization and you are very likely to get a confused response. If you ask around the fraternity, you will clearly notice two schools of thought. On one hand, there are those who champion prior auth by deeming it necessary for ensuring better cost control and fair billing (aspects that chiefly benefit payors though). On the other hand, are the naysayers, the ones who find prior auth requirements an unnecessary burden on billing operations, eating into their time and resources.

The Seamier Side of Prior Authorization

The debate continues to rage, and is not likely to be resolved anytime soon. But till a verdict is reached, whether we love it or hate it, prior authorization will continue to remain an important cog in the entire medical billing machinery, a part of the revenue cycle that we just cannot afford to ignore.

The opinion against pre authorization continues to gather momentum with elite cohorts such as the AMA (American Medical Association) making the cause for reducing prior authorization burdens a key priority of its advocacy efforts. Voicing the opinions of a large number of medical professionals across the USA, the AMA has stated that it wishes for medically necessary clinical services and prescriptions, as covered by various health insurance plans, to be provided to the patients without delay.

On a related note, a survey conducted by the AMA in 2021 had revealed that 93% of physicians reported care delays which were linked to prior authorization, while 82% mentioned that prior auth demands can sometimes lead to patients abandoning treatment.

The Solution We All Want

It is clearly evident from the above that prior auth is not a very simple process. It may not be complicated but it demands a large share of time and effort. While the process continues to dwell in its own land of confusion and stand like a Tower of Babel in the realm of healthcare billing, practices everywhere cannot help but keep struggling with the dastardly demands of prior authorization.

A viable solution that brings in a breath of respite in this all, is appointing professional, dedicated prior authorization specialists to get the job done on behalf of the physician’s office. When one takes into account the tedious steps associated with prior authorization, such as filling up of forms, making multiple calls to the insurance, following up on pending requests and the long waits, having a dedicated expert handle it all on your behalf is a tempting proposition. And in most cases, it also makes better business sense as it can drastically reduce operational costs, save time and bring in a better rate of success with all the prior auth requests that go out from the physician’s office.