Fascinating Secrets To The Prior Authorization Adventure

I stop my reading after seeing the letter from the insurance company that states the needs of a prior authorization process for a medical procedure. While it is true, that prior authorization is primarily a process that safeguards the interests of the patients from drug abuse and costlier medication exploits, yet the need to provide a compelling medical reason becomes hazardous for a doctor’s office.

Poor Communication with The Payers Looms Large

The insurance company drifts the doctor and makes them choose less expensive alternatives. Prolonged phone calls, tedious paperwork, and bureaucratic conflicts are the pain areas that every practice experiences with prior authorization process.

  • The sad part is the patients that should be receiving the benefits of prior authorization bears the brunt due to prescription abandonment and delay in the medical procedure.
  • Pre authorization requests on an estimate take away 20 hours a week for any medical practice. Nearly 13 hours of the nurses time and six hours of clerical time are consumed that can utilize for better patient care possibilities.
  • Apparently, pre authorization saves money for the payers on an upfront basis. The physicians soon surrender to the challenging process. However, the entire health system suffers hugely with prior authorization costs.
  • On an annual basis, prior authorization costs amount to a whopping $32 billion. The time and money spent can surely be put to better use by improving care management efforts.

Patients Suffer due to Prescription Abandonment

A study on the records of 4000 patients suffering from Type 2 diabetics clearly indicates that those who were denied the medications had higher costs overall in the following year. Also, not getting medications at the right time made their conditions to deteriorate.

Electronic Prior Authorization Advantage

Controlling the costs of medication and bringing about sanity in the prior authorization process should be the need of the hour. Electronic prior authorization (EPA) provides the desired automation and helps in streamlining the entire process.

A seamless integration with the EMR system helps in securing fast authorization approvals that improve denial management attributes in the long run. Leveraging from the technology upgrades will be crucial for the providers if they want to stand a chance in the competitive landscape.


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