Remember the feeling you tried to solve Rubik’s Cube for the first time? Challenging, right? Navigating the prior authorization maze in healthcare can sometimes feel a bit like that. It is a frequent source of frustration for many working in the healthcare revenue cycle management (RCM). While deemed necessary by the payers as part of the reimbursement process, prior auth is an extremely time-consuming piece of the revenue cycle puzzle.  

The average prior authorization request and status check take 12 minutes and 7 seconds. Prior authorization is not just a time sink, it is also a burden. 88% of physicians associate a high or extremely high burden with pre-authorization. And another 79% say the PA process, like always, often, or sometimes leads to patient abandonment of care.   

Making matters worse, many providers note an increase in prior auth requests for prescriptions and medical services. This increase, paired with the average time of authorization submission, means a large loss of valuable time.   

Payers have continued to expand services that require prior authorization for medical services, procedures, and treatments to patients to ensure the services are medically necessary, appropriate, and cost-effective. However, the process has become increasingly complex over the years, especially after the shift from fee-for-service to value-based care.  

It involves complicated steps that include gathering and submitting medical documents to ensure companies, waiting for approval, and often dealing with denials and appeals.   

Additionally, every year guidance is becoming stricter around the extensive document required for authorization. Procedures are being added that historically have not needed authorization. It is a growing challenge for the staff to understand the required clinical documentation and office notes required to support the authorization, and the administrative requirements have far-reaching impacts on finances, operations, and patients.    

The prior authorization process is burdened with extensive documentation requirements. Understanding the documentation requirements demands extensive knowledge and understanding of the processes. Therefore, it is crucial to stay updated on insurance policy alterations and new regulations. Think of it as a software update on your computer, you need them for optimal performance.  

Continuous training and education of your employees will help them sharpen their skills, reduce mistakes, and streamline the prior authorization process. A well-informed staff can communicate effectively with the patients, providing clarity on the nuances of their insurance coverage and what to expect in terms of treatment and billing.   

Implementing a standardized preauthorization process helps healthcare providers streamline their workflow, ensure compliance with payer requirements, and improve patient outcomes. Investing in the training programs ensures that staff has the necessary skills to navigate the PA process. Providers should leverage their payer relations team, subscribe to the payer newsletter, attend webinars, and participate in professional organizations to stay informed on the latest process requirements.   

The administrative burden of the prior authorization process has increased steadily over the years, leading to additional costs and workload. It increases administrative costs within the healthcare system.   

Denied PA upfront or during the adjudication process results in revenue loss for healthcare providers and can be difficult to overturn. Delayed cash flow is another major concern for providers regarding the daunting PA process.   

The time and resources spent on authorization administrative tasks can take away some other important tasks, such as coding and billing. The authorization process adds to the workload of revenue cycle management staff without necessarily increasing the number of staff members, leading to burnout and staff turnover.   

The complexity of the process can lead to several delays in care or additional denials, resulting in a negative impact on patient satisfaction and quality of care. 

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One of the most critical strategies for navigating the PA maze is to optimize and develop a workflow that benefits the provider's bottom line. Healthcare providers need to ensure that they have the highest resources to ensure a streamlined prior authorization process.   

To eliminate the challenges of the authorization process, you can consider partnering with an outsourced RCM partner. Sourcing remote support from a reliable organization can help you enhance your revenue.   

With a team of prior authorization experts, you can enjoy the benefits of industry-comprehensive technology and standard practices in the authorization process. Furthermore, the team of dedicated professionals works on your PA denials to ensure reimbursements and quality care process.   

Finding an RCM partner and handing over your financial aspects to a third-party organization is quite difficult. Choose a trustworthy RCM organization that can navigate your ROI in a positive direction in the long term by reducing errors within the process.