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Improve your Prior Authorization process

It is one of the most exasperating challenging tasks for physicians to obtain prior authorizations for prescriptions and testing in their services. In the physician’s percept, prior authorizations are nothing but it’s just insurance companies inserting themselves into the care decision-making process, creating problems for both doctors and patients. Physicians say they have to face long waiting times for insurers to process prior authorizations and the delay can negatively impact on patient outcomes.

Prior authorizations wave

According to a study done by the American Medical Association, 86% of physicians reported that prior authorizations have increased during the prior five years and 51% reported that they have increased significantly. According to the health insurance industry, prior authorizations are an important tool adopted by health plans and government-sponsored healthcare programs to help ensure patients receive the best care.

Health insurance providers have a 360-degree sight into how patients use their care and coverage and they are committed to helping people get better when they are sick and keeping them healthy when they are well. It takes teamwork between health insurance providers and clinicians and hospitals.

Providers can trounce the burden of dealing with prior authorizations by automating the process, proactively checking necessities and using staff to focus on prior approvals.

The following strategies cannot eliminate the administrative hassles associated with health plans’ PA requirements but they can help you and your staff to improve practice efficiency and successfully manage the PA process.

  • Check PA requirements before a startup to provide services or sending prescriptions to the pharmacy. Put off medical service claim denials and lost payments due to unmet PA requirements. Ensure that the pharmacy will not make it late in filling a prescription due to unmet PA prescription requirements as well as prevent medication no-adherence
  • Establish a set of rules to consistently document data required for PA in the medical record.  Find ways to avoid delays in patient therapy.  It will not only prevent potential follow-ups with patients for collecting additional information but also reduce the physician time needed in the PA process
  • Select the PA method that will be most efficient and effective for the given particular situation and health plan PA options. This will reduce your practice time spent on PA and lessen the workflow disruptions by selecting the best available PA option efficiently as well
  • Automate the prior approvals and make the process more efficient to prevent errors, thereby saving time and money. Application program interfaces (APIs), artificial intelligence and natural language processing (NLP) will allow vendors to offer more prior authorization solutions for medical and pharmacy services.  It helps to establish an electronic review track and protect health information that is encrypted for security
  • Regularly follow-up to ensure timely PA approval to help prevent delays due to information lost or not received by payers. Practices can also view a list of electronically submitted and pending prescription PAs in their EHRs. When a PA is incongruously left off, submit an organized, short and well-articulated appeal with supporting clinical information which will help to increase chances of appeal success and reduce treatment delays for your patients
  • Physicians need to effectively communicate with patients regarding prior authorizations and it’s often better to deal with the matter proactively with patients rather than wait until the treatment has been denied

The goal of the above tips is to establish a set of recommended practices to help improve the current prior authorization environment and to react to the prevalent challenges and discontent that healthcare professionals have with prior authorization.

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