Prior authorization is well known as one of the most challenging and time-consuming activities within the system of healthcare providers. This issue has been in the industry for several years, and various experts have argued whether it is efficient or not.

Digital developments present possible solutions for making PA less problematic and time-consuming. Therefore, advancing knowledge of the PA process is the key to simplifying it. It becomes necessary to have a big picture and encyclopedic understanding to work through the issues effectively.

Cross-Industry Implications of Prior Authorization

1. Providers: While the prior authorization is coordinated by the payers, the providers are the ones that suffer the harassment of the process. The amount of time, effort and costs which are required to accomplish PA requests is of paramount importance to the workforce. Delays in approvals lead to adverse effects on patients’ appointment and treatment plans which will result in frustrations and deteriorated patient health.

Also, multiple denials of prior authorization contribute to increased administrative time not only adding to the cost of managing operations but also the time patients spend waiting to access the desired care. This becomes worse for independent providers or even healthcare facilities that have to contend with multiple payers and their different PA submission rules.

2. Payers: The PA process also becomes stressful due to its impact on payers. Payers utilize a highly qualified workforce including physicians and nurses to review every case systematically. Due to set timeframes within which the PA submission and review must occur, the staff is always under pressure. Adding to the challenge, more follow-ups from the providers and fewer workforce for reviewing such requests add to the woes of the payers with regard to the efficient handling process.

3. Patients: In the end, it is the patient who bears a huge cost which has emanated from the prior authorization services. Delays in the treatment process also leads to irritation due to decay of specific health conditions and patients may drop out from the treatment process. This ultimately results in poor health outcomes.

Intricacies of Prior Authorization

It becomes difficult for healthcare organizations today to develop mechanisms for coping with the complexity of PA process and scarcity of skilled employees. The main difficulties in PA are as follows:

1. Manually Intensive Process: PA involves many steps, with sequences carried out mainly outside the basic EHR work cycle. PA is a very time-consuming procedure, and if certain details are not recorded requests are likely to be turned down.

2. Constantly Changing Payer Rules: PA rules vary with each payer and because of changes in these rules on a frequent basis, the staff are always confused. A change within the system makes the previous guidelines ineffective and lack of understanding of the same increases the chances of error.

3. Lack of Transparency: Quite concurrent with this issue is frequent revision of rules compounded by the fact that many payers do not offer sufficient information. Some payer portals enable providers to search for an authorization’s details just with a code for a specific procedure. However, in other cases, it takes time to obtain the information.

Make Prior Authorization a Better Experience

There is a need to improve the preauthorization services as it is a central pillar in practice management. It is clear that technology and efficiency can help minimize administrative burdens, yet PA requires an integrated approach now.

Where there are inefficiencies, with communication between providers and payers being strained and a lack of transparency, the process can be made more manageable.

A strategic plan of outsourcing at hand is always useful. It is old but the all-time best solution to manage your revenue cycle.

These third-party organizations have a huge talent pool of revenue cycle management experts who can streamline your overall operations by providing you with an end-to-end service.

Navigating through preauthorization challenges is essential for practices to amplify the practice management and patient satisfaction.

Outsourcing the services from a prior authorization company should be taken very seriously by healthcare facilities as a viable way to improve billing and the financial outlook in the long run.