What are prior authorization services?
Some services rendered by healthcare practices require pre-approval from the insurance carrier before delivery. These services include complex treatments and medications that can only be carried out with proper authorizations.
Pre-authorization services is the process followed by insurance companies to determine if the prescribed treatment or medication is medically appropriate and is covered by them. This way they will know if the given service is to be fully or partially covered.
The Need
Healthcare costs are crucial for all the parties—insurers, practices, and patients. Keeping them in check is one of the difficult things to manage. However, with prior authorization services, that can be reduced to a considerable extent.
With Prior Authorization:
- Insurance companies can ensure if the prescribed drug is truly necessary for the patient, keeping their medical condition in consideration
- One can determine if the treatment is economically viable
- Find alternatives for the same medication in case of high costs
- Ensure up-to-date follow-ups and new recommendations for medical concerns
- There is no chance of service duplication, especially when more than one specialist is involved
- Ensure if the recurrent treatment or medication is effective or not
Why and How to Streamline the Prior Authorization Process?
Pre-authorization services take a long time to process, and with practitioners depending on reimbursements, it becomes critical to have a sophisticated solution or strategy that helps to streamline prior authorization.
The major need to streamline the prior authorization process is to gain outstanding patient outcomes. A delayed or lagged pre-authorization process will eventually build consequences for the treatment of patients and the desired outcome may get too far from what was expected. 2022 is a part of the digitally transforming market and demands an effective transition from all the lags and delays.
Here are a few ways to smartly streamline the prior authorization services:
Have a clear picture
Practices must know what they are doing, and why they are doing it, and draw them to a clear picture. This means that they must have a clear understanding of all the processes and improve compliance to boost the approval rates for healthcare practices. Practices must train and cross-train the staff to attain the level of clarity that is required to ensure an effective PA process. This will also help them to come up with efficient strategies to simplify the pre-authorization process.
Clear & effective communication
There must be transparency between the practice and insurance company to improve and strategize ways to enhance the PA service. For this, practices and insurers must incorporate systems that help with effective communication with complete safety. Effective communication will result in a better understanding of the relevance of the specific treatment or medication.
Speed up PA process
Manual methods have proven to slow the PA process and thereby impact patient outcomes. Practices and insurance companies must invest in technologies that would speed up the entire process that helps in attaining better approvals, thereby enhancing patient outcomes. There are other ways to improve the PA process:
- Bringing in a PA expert will allow practices to have an expert in hand
- Leveraging cutting-edge technologies like PA electronic and medical billing software
- Record clear and precise clinical data for faster and more accurate processing
- Design effective follow-up strategies
- Train the patients to have an understanding of prior authorization
Automation of Prior Authorization Process
Identifying accurate drugs and treatments for the patients can get tiresome if done manually. Automation is the ultimate choice to put an end to this torment. Adopting automated solutions will not only ease the manual effort but also enhances the efficacy of the PA services, increasing the chances of approvals.
Automation reduces the practice burden and allows them to access patient payment information in real-time. It also brings in an increased number of precise claims and reduces the denial rates.
Bring in the Gold Card System
Physicians can leverage the advantage of their expertise to provide a gold card to the patients, allowing them to have complete access to the care they had paid out for. The Gold Card system refers to the payment process that provides certain exemptions and advantages to physicians with higher PA approval rates. These providers can independently order and prescribe medicines to their patients with complete security, and the approval rates are almost guaranteed.
Final Thoughts
It is critical to deliver patients with timely and secure care whenever necessary. Putting that to a halt is not the best option for practices, and patient recuperation might also take the long road. Prior authorization services can get frustrating for the physicians for two reasons: one, is the revenue stream collapse, and secondly, inefficiency in patient care. Therefore, practices need to protect their community and deliver the best medical support at any cost.
