Meeting the demands of Prior Authorization
Billing for a medical service and seeking reimbursement from the patient’s health plan is a complex process, comprising many different steps. Of these, prior authorization is a very crucial one. It is also a process that tends to attract a lot of negative criticism, owing chiefly to its tedious nature. Yes, obtaining prior authorization for a prescribed medication, therapeutic device or procedure can take a large bite off the provider’s time. It’s also a bane for patients, and horror stories abound about the adverse effects resulting from the usual delays associated with the process where patients had to abandon treatment, fall back on a less costly but ineffective treatment, or had to suffer more serious consequences due to the lack of timely medical intervention.
A recent survey conducted involving practicing health care professionals has revealed that on an average, about 2 days’ worth of time is spent on prior authorization in a typical week. The lengthy nature of the process can be attributed to the fact prior authorization is still carried out using the last century’s methods. In spite of the growing prevalence of electronic prior authorization, many providers (and payors) still insist on doing it in the old-fashioned way involving tons of paperwork, sending faxes and making plenty of phone calls. When one takes into account such antiquated methods, and adds to them the long hold times on the phone as the provider’s office waits for the insurance company to check the patient’s details in real time, it is easy to see why the task of obtaining prior authorization can sometimes get so frustrating.
Can outsourcing help?
In one word, yes. It is evident that prior authorization is a process that requires dedicated resources and plenty of time. And both of these come at a cost for any provider. Outsourcing prior auth tasks to a specialized, third-party medical billing agency can help to drastically reduce cost and save time. Offshore outsourcing can be a veritable godsend in this regard as it allows providers to get all their prior auth requests completed at a fraction of the usual cost. Offloading the process to an external agent also allows them to free up their resources that were hitherto engaged in the tedious process and find more time to pursue other critical activities such as actual patient care or expanding the current practice.
Outsourcing also means that providers get specialized and dedicated attention to all their billing requirements. This results in an overall improvement and better streamlining of the revenue generation cycle. Collection rates go up, denials decline and operational costs get slashed by up to 80%! In short, if sustaining operations without burning a hole in the pocket is the real concern, no provider can really afford to overlook the many benefits of outsourcing.