- September 12, 2022
- Posted by: Steve Smith
- Category: Prior Authorization
Understanding the Prior Authorization Flow
Prior Authorization, which is also known as pre-authorization or pre-certification, is a step in the medical billing chain that is crucial for ensuring reimbursement by insurance companies. It is essentially a mandate introduced by insurance companies to check healthcare overspending. It also aims to ensure patient safety by scrutinizing drug interactions, adverse side-effects and such other allied issues. However, the main aim of prior authorization is to make sure that a medical treatment (such as a prescribed medication, procedure or the use of a therapeutic device) is absolutely necessary to treat the patient’s condition and cannot be achieved by using a cheaper, more generic variant.
The chief complaint with prior authorization is the amount of time it usually takes. In spite of the growing prevalence of electronic prior auth processes which have practically reduced this time to a great extent, many providers still continue to do it the old-fashioned way, involving copious amounts of paperwork, umpteen faxes, and long calls made to the insurance service desk. A recent survey has revealed that on an average, a week’s load of prior authorizations can amount to almost 2 working days!
Expediting The Process with Smart Measures
Prior auths are a tedious affair. True. And one can only make it worse if there is a lack of a streamlined approach to the whole thing. Unfamiliarity with the caveats of the process is another deterrent. What it really boils down to is a lack of experience in placing prior authorization requests, which can make the process drag on forever.
In view of these difficulties, healthcare providers have started looking beyond their regular in-house billing desk and seek professional assistance from revenue cycle management experts. Through strategic outsourcing of key billing tasks, providers have effectively expedited their billing and collections, reduced denials and loss of revenue, and have brought about an improved rate of claims getting passed at first go.
Having an experienced and skilled prior authorization expert working for you can brings a host of benefits. This is especially true when the volume of request is high. Such experts can get more requests completed in less time, leaving your immediate staff with more time to pursue more important tasks than spending hours behind the desk, chasing the prior auth request. And this is the kind of smart business move that no healthcare practice can afford to ignore.