Why Should you Outsource your Authorization Process?

Prior authorization (PA) in medical billing consists of the process where providers determine the coverage of a rendered service, and the payer is authorized to pay for the service or treatment. 

Without authorization, the insurance payer is free to refuse the payment of a patient’s medical service as part of the health care insurance plan. For any service that requires authorization, if you do not obtain one, your claim will be denied and never paid. 

Your practice needs authorization for services that require it to keep costs in check, ensure medical necessity and reduce duplicated services. 

Authorization is a complex process  

According to the American Medical Association (AMA), prior authorization is overused and existing processes present significant administrative and clinical concerns. The 2021 AMA prior authorization (PA) physician survey stated that:  

  • 34% of physicians report that PA has led to a severe adverse event for patients in their care.  
  • Practices complete 41 PAs per physician per week, on average.  
  • Physicians and their staff spend an average of almost two business days each week completing PAs.  
  • 88% of physicians describe the burden associated with PA as high or extremely high. 

Prior authorization requirements can sometimes lead to delays or denials for care. These roadblocks cause frustration and worry for doctors, hospitals, and patients while adding to the mountain of paperwork doctors and hospitals must do. 

Partner strategically to improve your prior authorization process  

The prior authorization process can take valuable time from providers that can use it to care for patients. Experts in this field can help you reduce burnout of your current staff and allow them to focus on higher priority tasks. 

The future of PAs lands on automation. Fully electronic prior authorization is accelerating. Your current patient access workflow needs to be integrated with your authorization workflow to prevent delays in patient care and reduce denials. 

A strategic partner will help you identify a potential opportunity for automation while relieving you of the administrative burden. For those authorizations that cannot be automated, it is essential to have experienced trained specialists to handle those exceptions. 

Among other things, by outsourcing your Prior Authorization process, you will be able to:  
  • Reduce denials.  
  • Save time and money.  
  • Minimize data errors.  
  • Improve patient care.  

The healthcare industry landscape is changing at an evolving pace. Finding a partner to help you solve your authorizations today is crucial. And can also prepare your practice for solving authorizations in the future. 

To learn more about outsourcing your prior authorization process, get in touch with an AdvantEdge expert or stay up to date on company and industry trends by visiting our Linkedin page.