All you need to know about prior authorization, pre certification or pre authorization

What is Pre-authorization? The American Medical Association describes Prior authorization which is sometimes called precertification or prior approval— 'as a health plan cost-control process by which physicians and other health care providers obtain advance approval from a health plan before a specific service or treatment is delivered to the needed patient to qualify for payment coverage.'  

Troubles of prior auth services: 

Mainly done to control costs and minimize denials, the process of PA however accordingo a new survey currently causes 92% of care delays, treatment abandonment and around 853 hours annually are wasted for the purpose of managing prior authorization transactions. In fact, taking up a lot of physician time on average, physicians obtain 29 medical approvals per week, while 23% report their staff completing over 40 PA requests on a weekly basis. The AMA also in its recent reports further states that pre-certification consumes approximately 1 hour of physician time, 13.1 hours of nurse time, and 6.3 hours of clerical time per week, totaling 853 hours annually per full-time physician and costing ,975 in labor. 

With more than half which is eighty percent of physicians complaining of occasionally, often, or always they need to repeat PA requests for prescriptions when a patient has already been stabilized on treatment. Additionally, 86% of physicians report increased PA burdens in the past five years, with the AMA projecting a 20% annual increase in PA requirements in the years to come.   With all such complications and as time Equals Money today outsourcing prior authorization services is not only the best solution but also a convenient way out for many providers. This is because when considering opting for in-house prior auth which deals with faxes, phone calls, clinical time, and other factors, the labor costs for physicians range between and 0 per pre-authorization. This is why today outsourcing from a prior auth company has been the easiest and fitting way out for many providers and practices. 

Soin 2023 if your main focus is mostly dedicated to regaining control in your practices by implementing electronic pre-authorization (ePA) or looking to reduce the prior auth burden at a cost effective rate, there are RCM solution like Sunknowledge Services Inc that can help.  

Catering to all your prior auth needs from authorization initiation, approval and follow up; Sunknowledge experts take care of it all. 

For more information on how Sunknowledge can make a difference, call Sunknowledge now!