Prior Authorization Challenges With Denied Payments And Write-offsPrior Authorization Challenges With Denied Payments And Write-offs

On an estimate, it has been found out that 868.9 million hours are been spent on an annual basis to just obtain prior authorization according to the Kaiser Family Foundation. Healthcare providers need to dig deeper, find out viable best practices that will help them get better in their practice management priorities. More than $31 billion is getting spent on prior authorization, hindering the objective of achieving excellence in rendering value-based care in best proportions.

The pain areas with the patient access departments with the lack of the right resources and information, determining the right way out and focus better on patient care is the most important aspect. Prior authorization sets the foundation for an improved revenue cycle management approach. The right checks and balances, setting the tone for better accounts receivable reimbursements become a huge challenge for a healthcare practice.

Countless hours of a practice is getting spent on paperwork. No wonder, a huge number of physicians across the United States are complaining of getting exhausted, burnt out in their professions. A Web MD/ Medscape survey clearly recorded almost 54% among 25,000 physicians not looking to choose medicine again as a career option!

The right support helping to focus better on patient care

Finding a service partner that can render effective support by working as a flexible operational extension can be great! A complete prior authorization action plan provided by a powerful healthcare revenue cycle management company will help a practice reduce their operational expenses to a great extent.

Right from gathering of important information from the provider office, the patient on the medical procedure, checking the eligibility of patient, verifying and validating PA request with seamless communication with the insurance companies, following insurance mandates while initiating auth request, checking the prior authorization status, collecting the relevant documents, following up with the ordering physicians, providing any additional information as needed by the insurance companies and updating the outcome of the prior authorization in the Billing system/PM of the client, streamlined support from the right partner will be crucial.

Rising wait times for prior authorization

A study done by the American Medical Association (AMA) clearly indicates the problems with delayed treatments and cancellation of prescriptions. Almost 60% providers stated that they had to wait for at least 1 business day, while 26% recorded to wait for as long as 3 business days!

The failure of securing authorization in a timely manner can have a drastic impact on a practice’s regular finances at large. Insurance companies are definitely not going to pay for a medical procedure if they do not receive the correct form of prior authorization. It often acts as a restrictive phenomenon as the patients are also not getting billed.

Physicians at large are still stuck between tedious manual processes involving prior authorization. As something that was intended to serve as a benefit for the patients, it often restricts physicians to render a proactive care management solution. Patients cannot suffer and more impetus must be given to personalized care. Burdens with prior authorization need to addressed, better communication between payer-provider-patients has to be meted out for a better healthcare delivery.

While Prior Authorization is an integral part of medical care and medical care, there is no obvious lack of it. Even medical professionals and healthcare professionals will give many answers when asked for prior approval. Most of them can not describe or develop it. Unfortunately, the internal staff of doctors, hospitals, laboratories and other medical service providers are not always the best they know about the Prior Authorization process. These people are already overburdened by assuming different responsibilities; You can afford very little time for an upgrade in advance. Things get more difficult because, despite limited information, they often need to be included in a Prior Authorization process. No wonder the process suffers. Few of the leading prior authorization services also provide end-to-end practice management /revenue cycle management guidance to various healthcare providers.

by Willam Smith
References and Bibliography
This author has near about one-decade experience in Online prior authorization field and that's why he is interested to share his working experience on this website. Also, he is associated with one of the biggest healthcare support organization PriorAuthOnline.
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