What is Prior Authorization?
Prior authorization (PA) is a requirement that the provider obtain approval from your health insurance plan to prescribe a specific medication or treatment. This health plan cost-control process often delays care unnecessarily at the expense of the patient’s health and the practice’s resources.
What is the Process for Obtaining Prior Authorization?
For most prior authorization, providers have to follow multiple steps. This can involve securing the correct form, filling it out with the required information, submitting the form to the plan, etc. In particular, holding time is long when trying to reach a customer service representative in the insurance company. The time to submit one prior authorization can reach up to 60 minutes. An AMA survey of 1,000 physicians completed in December 2018 found that physicians completed an average of 31 prior authorization requests each week! A study by Health Affairs further revealed that when the time is converted to dollars, practices spent an average of $68,274 per physician per year interacting with health plans. This is all lost time and cost that clinicians could instead be spending with and on their patients.
What is the Clinical Impact of Prior Authorization?
The AMA study also found that more than nine in 10 said prior authorization rules had a negative impact on clinical outcomes. More than a fourth of respondents said these requirements had triggered a serious adverse event — a hospitalization, permanent injury or disability, or even a death — for a patient in their care.
What Can You Do to Improve Your Prior Authorization Practices?
Insurance companies are not going to stop requiring prior authorization. In fact, insurance companies are increasing their PA requirements. Practices face many challenges with PA, including issues submitting documentation manually via fax or through the health plan’s proprietary web portal, as well as changing medical necessity requirements and appeals processes to meet each health plan’s requirements. By using a centralized system for PA, you can reduce your costs, improve your efficiency for submitting prior authorizations, and reduce denials for lack of PA.
At LRS, our verification and authorization team understands how to work with payers. We have the institutional knowledge to complete PA's in a proficient and timely manner. Contact LRS today (inquiries@lincolnrs.com) to see how our centralized verification and authorization process can help to reduce your administrative costs and burdens.