Prior Authorization Services for Practices Struggling With Staffing Gaps

The majority of small and medium healthcare practices are facing a serious staffing shortage in the U.S. We all know that hiring new staff always takes a considerable amount of time and money, while the overall workload is showing no signs of going down. Prior authorization only further makes the administrative hassles difficult to manage. The whole objective of prior authorization is pretty straightforward. Insurance payers use prior authorization as a utilization management tool to ensure the administered procedure or service is medically necessary. It also ensures that the proposed care is evidence-based, and covered under the patient’s insurance plan. An insurance payer is always likely to refuse payments if a PA request is denied, thus leaving patients to pay the amount on their own. A single mistake in the prior authorization process can lead a practice to face unwanted payment denial.

Know about the harsh reality of prior authorization services:

Now, the concerning fact is that though prior authorization aims to improve the overall clinical care with proper cost justification, still, 29% of physicians admitted that PA always caused severe negative consequences for their patients. It causes more hospitalizations and deaths.

The same survey also demonstrated the fact that almost 93% of physicians admitted without any hesitation that unwanted care delays occurred. 82% of physician in that survey also reported that their patients were abandoning treatment midway. CMS had no option but to intervene and introduce the Interoperability and Prior Authorization Final Rule (CMS-0057-F) in January 2024. It requires insurance payers to act fast and use electronic systems to reduce any care delay. Staffing gaps, patient risks, regulatory pressure, and financial losses are some of the vital reasons why more healthcare organizations now turn to outsourcing their prior authorization process. Practices can easily access trained experts, faster approvals, fewer denials, and smoother revenue flow with outsourcing, while freeing in-house teams to focus on patient care instead of insurance hurdles.

Let’s understand what the outsourcing of prior authorization service is, the challenges with staffing shortage, and the hidden costs of managing PA in-house.

Related Reading: Optimizing Prior Authorization: How to Handle Challenges and Boost Productivity

Learn about the concept of prior authorization outsourcing:

Prior authorization outsourcing means handing over the process to a specialized company. These companies have trained teams who know payer rules, medical codes, and documentation needs so that practices can always enjoy a seamless PA management workflow.

Know how staffing shortages make prior authorization more difficult to manage:

The majority of hospitals and clinics struggle with staffing. The number of phone calls always piles up, managing PA requests takes longer, and patient waiting time increases when a practice is running with limited staff members. Prior authorization alone can take up to two days per request, and it often overwhelms practices with hundreds of patients every month. A lot of healthcare practices still feel that managing PA is an easy affair but things always become difficult when they need to spend on hiring new staff members, mitigating denials and ensuring patient satisfaction.

The following are the key ways how outsourcing PA services can help healthcare practices.

Know about the vital ways how outsourcing prior authorization services helps:

Significantly reduced administrative hassles

Your staff members do not need to spend their time making phone calls and other payer follow-up measures with an outsourcing partner. You can always ensure an improved patient-satisfaction score when you dedicate the team to focus on elevating the level of patient care.

Reduces Denials

A professional prior authorization service provider has a team of trained and experienced professionals who know all the payer rules, coding systems and documentation process. Most professional PA management teams work around the clock to ensure zero pending requests for a day. Healthcare practices can always ensure faster patient access to tests, treatments and medications when they have professional supporting hands.

Cost-Effective

The good thing about outsourcing is that it allows you to delegate dedicated staff members to work on prior authorization services at a highly economical rate, like $7/hour.

Scalability

A professional company always offers excellent scalability to medical practices, as they can easily scale up as per the real-time requirements of a healthcare practice. A professional prior authorization service provider also knows how to immediately reduce the number of their resources when practices see less patient volume.

Are you looking forward to finding the best prior authorization service provider who can ensure all the benefits mentioned above? SunKnowledge Inc. is the ideal partner to vouch for.

Related Reading: 2026 Regulations That You Need to Know to Ease Out Prior Authorization Complications

SunKnowledge: The perfect prior authorization partner for you

We are the only RCM company that works for both payers and providers, which empowers us to be the master of all PA rules set by different payers. Our prior authorization experts always know what it takes to handle 20 PA requests each day with utmost accuracy. We always leverage the leading ePA tools to ensure fast and clean PA request submissions so that you can enjoy cost savings on faxes, phone calls and unwanted waiting time. Our experts recently worked for an HME supplier and fixed vital issues like missed credit adjustments and incorrect reason selections, and helped them with a 46% reduction of missed adjustments in one week, with 87% of improved accuracy. We also offer end-to-end RCM services along with medical virtual assistance services to free up your existing staff from performing the critical administrative jobs.

Don’t let prior authorization bog your practice down! Enjoy a perfect workflow of prior authorization services that allows you to see the maximum approval rate with SunKnowledge Inc. today!