Even as state legislature continues to introduce new laws aimed at lessening the burden on providers and a general outcry continues to surge demanding a radical overhaul or a complete prohibition, prior authorization is going to stay with us for some more time. Essentially a payor-side requirement, put into place to keep medical costs in control and to ensure safe, appropriate treatment, prior authorization is often looked upon by providers as a deterrent to pursuing more useful tasks.
For one thing, it is a time-consuming process where one has to spend many precious minutes to get even a single prior auth completed. There are long times that are spent on hold while trying to contact an insurance company and obtain the requisite authorization for a proposed treatment or medication. For another, there is also a good deal of paperwork involved, which, to make matters worse, keeps changing from one insurer to another. This is a major problem because, even with the growing acceptance of its electronic variant, prior authorization continues to be done in the traditional paper-fax-telephone mode in very large measures across the US. In view of the above, it’s no wonder that a large number of practices, especially the busier ones, choose to outsource all their prior authorization tasks to dedicated, third-party agencies. Understanding payor-specific preauthorization requirements, following up with the provider’s office on missing information that is required to complete the authorization, and managing denials are activities that very often suffer from a lack of consistency and slip-ups. Many individual practices often find themselves understaffed when it comes to engaging medical billers who understand the complex and varied requirements of different insurers. This is where outsourcing can make a big difference. Competent third-party companies keep their team members up-to-date with training and compliance. They ensure that prior auth requests are made and completed in time, and fewer of them are denied or rejected. As a result, they can bring about a noticeable increase in the prior auth approval rate and increase overall collections for the practice. Dedicated prior authorization service providers can be a real boon for busy healthcare practices as they help in freeing up resources, reduce overhead and generate more collections.
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