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Need for Prior Authorizations Continues to Increase

MGMA Poll Shows Need for Prior Authorizations Continues to Increase

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A recent poll by MGMA showed that 79% of those polled indicated that prior authorizations (PA) requirements had increased when asked “How did payer prior authorization requirements change in the past 12 months?”. Only 19% said they stayed the same and 2% stated they had decreased.

They also noted significant challenges associated with the increase in PA requirements:

  • Slow or lack of response from payers on approvals
  • An increase in time spent by staff to obtain PAs, which has been compounded by the shortage in staff amid the tightened labor market
  • Patient care delays due to lack of PAs

A study, by the AMA, showed that 88% of physicians responded that handling PA requests are either a “high” or an “extremely high” burden on them and their staff. Over 90% of respondents stated that PA requests “often”, “always”, or “sometimes” hold up patient care. The survey also found that an average of 13 hours a week are spent by medical staff completing PA requirements for medications, medical services, and procedures that are needed. That is the equivalent of almost two days per week spent obtaining prior authorizations.

Patient Care Suffers

A concerning downside to the increase of prior authorizations has to do with actual patient care. When asked, 29% of physicians said they waited at least three business days to receive a response from the payer, and 64% said they waited one business day. A number of physicians have reported that prior authorizations have led to adverse patient events due to not receiving a PA promptly. Or patients have abandoned treatment completely due to the time-consuming nature of prior authorizations and not being able to move ahead with treatment immediately.

Insurance Companies Keeping Costs In Line

It is understood that insurance companies want to keep costs in line. Prior authorizations are their way to control costs by determining if a procedure or medication is medically necessary, being duplicated, if there is a less expensive option, or if it is even covered under the patient’s insurance plan. However, prior authorizations take a lot of administrative time to procure. There are forms to complete and sometimes follow-up calls or faxes that need to happen. All to ensure that the PA is received promptly to minimize any delay in medical care and avoid a medical claim denial.

How to Reduce the Stress

In an effort to streamline the process for your practice, without taking on the burden of another employee, which includes salary, benefits, training, and unfortunately, turnover, outsourcing this function can be the answer. Hiring a company that specializes in obtaining prior authorizations can save you time and increase revenue. Easing the stress on you and your office staff and allowing the focus to return to providing your patients the quality care they deserve.

How Billed Right Can Help with Prior Authorizations

At Billed Right, we specialize in revenue cycle and operational management, including offering a prior authorization service as an add-on solution. We can provide you with peace of mind that your PAs are being requested, followed up on, and filed appropriately in your EHR software. This helps avoid medical claim denials, patient frustration, and loss of staff time.

Our team of experts understands all the ins and outs of obtaining prior authorizations and submit authorization requests within 12 – 24 hours, follow-up with payers ensuring that they are received quickly, and work within your EHR so that your staff has access to them when they are needed.

We are more than a vendor, we are a strategic partner, working hard to support your practice’s growth.

Contact us today to learn more about how we can help by handling your prior authorizations!

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