Prior authorization causes headaches and frustration for physicians and medical practices. Clinicians usually blame the issue of prior authorization for a delay in the treatment and care of patients. Prior authorization helps to prevent any unnecessary spending but adds up to the administrative burden. What exactly is prior authorization? In simple words, it is a strategy where the costs are controlled by payers and ensure the requirement of the recommended medical treatment to the patient. This however delays the services that need to be offered to the patient. Prior authorizations are time-consuming and frustrating and are a burdensome problem which has a great impact on primary care providers by delaying care.
Strategies you can utilize to reduce the burden of prior authorization
Thankfully, healthcare providers and medical practices are not completely hopeless in dealing with the issue of prior authorizations. There are a few strategies that can help to take off this burden and help them deal with patients more efficiently for the best outcome levels.
- Have dedicated staff members – Have staff members specifically dedicated to the issue of prior authorizations to help maneuver the process quickly and professionally. The staff will act as a connection with healthcare insurers to help your practice deal with prior authorization like experts.
- Make use of technology – By leveraging technology you will be able to automate the process. By using integrated Electronic Medical Records (EMR) software solutions with your existing system can get rid of manual procedures which will ultimately save a lot of time.
- Create a directory – A good way to manage prior authorizations is to eliminate the need for them. You can create a directory or a spreadsheet that will show what is allowed under a payer’s plan. This will act as a reference guide for the next payers in line.
- Prescribe generic drugs – Providers should prescribe generic drugs when possible as it does not require prior authorization.
- Streamline processes – It is advised that you establish proper workflows to record every step of the process. Document every step of the prior authorization process with each company.
- Create pre-populated forms – practices can systemize the process by using pre-populated forms. When possible use the insurer’s own forms and listing codes which are required to process a prior authorization.
- Establish healthy relationships – Building strong and healthy relationships with the payers can also drastically reduce the burden of prior authorizations. Payer-related problems can be dealt and solutions can be sought when you have a specific person who would actually listen to you. Healthy relationships are a plus in the future for your medical practice.
Conclusion
The aim of prior authorization is to make healthcare more cost-effective and safe and appropriate for everyone involved in the healthcare sector, however, whatever the goal is most healthcare providers find it as a barricade in delaying treatment and also see it as an administrative burden. Processing prior authorization requests can take time which can impact the condition of a patient and strain the practice with additional administrative tasks to be carried out. Some states in the United States have electronic prior authorization requirements for medications which makes the process faster and more efficient.
