Prior authorizations are one of the most time-consuming, onerous aspects of the fee-for-service healthcare system. Just as doctors: AMA research shows that 84% of physicians consider the burden of prior authorizations as high or extremely high.
The general drudgery and payer-provider coordination involved in prior authorizations weighs down administrative and clinical staff alike – making them a key contributing factor in issues like physician burnout and staff turnover.
But the inefficiencies hurt more than employee satisfaction and operational performance. Wait times for prior authorization decisions often take three days or more. In that time, patients may change their mind or abandon a course of action – harming their potential to see positive health outcomes from provider-recommended care.
The damage is exacerbated by errors. Sometimes, poor coordination means providers wait days for “authorization” of services they were already ok to render; other times, insurers’ mismanagement means auth requests slip through the cracks.
Groups like the MGMA and AAFP are taking aim at industry expectations, saying they drive up the cost of care while undermining doctors. And a solution to the problem may be coming: In early 2018, the AMA joined with several leading insurers and insurance industry trade groups to issue a consensus statement that announced their commitment to improving the prior-authorization process.
But until they improve it, practices have no choice but to improve their existing efforts (or otherwise risk losing more time and money to authorization errors and delays). A few strategies can help providers minimize the burden.
Embrace electronic processes. Electronic PAs for medications – covered under either the pharmacy benefit or the medical benefit – have been around for a while. Even for procedures and services, e-solutions and eligibility checking software can help; since the systems leave a digital trail, providers can keep closer tabs on requests and statuses.
Outsource authorization efforts. Medical billing firms have a deeper bench of talent and expertise for understanding nuances among payers, following up on authorization requests, and challenging unwarranted denials. Working with a medical billing service that utilizes cloud-based technology (integrated with your EHR) can improve visibility and approval rates.
Optimize your approach. Design your requests for success. Keep a list of payer criteria for prior authorizations on hand so physicians know what kind of information to include to better the chances of success. Make calls at low-volume times of day to increase your odds of reaching payers. And pay attention to denials to know what went wrong, and why; by applying the knowledge over time, you can decrease rejections and better plan courses of treatment for patients.
...and if you need help from a medical billing company...