Prior Authorization Pains and How to Implement Checks and Balances

Posted by Willam Smith on August 15th, 2018

Almost 66% of the medical prescriptions at the pharmacy need prior authorization. When there is a requirement with prior authorization, only 29% of the patient ends up with the original prescribed item. Nearly 40% completely abandon the therapy altogether!

• Not only is this negative for the pharmaceutical companies, patients does not get the medicine to treat their ailments promptly. They bear the brunt of cancellation of medical procedure, prescriptions resulting in delays!
• For most prior authorization, physicians have to follow multiple numbers of steps. This involves securing the right form, filling the required information, submission of the form to the plan etc. With hold times being 20 minutes or more, in trying to reach a CSR of an insurance company, matters become worse. Almost all physicians will tell you that long holding times are catastrophic will PA submissions taking 30-45 minutes for each!
• A recent survey found that almost 86% of the physicians feel that burdens with prior authorization has increased over the last five years, taking away time to treat the patients. A comparative study done by the Health Affairs revealed that medical practices spent almost ,274 per physician on a yearly basis for just interacting with the health plans!

This almost amounts to 21 billion and 31 billion on an annual basis. It is true that prior authorization costs more to a health system than it can save! While prior authorization was introduced as a cost containing measure, the labor intensive measure associated with providers, patients, pharmacists, benefit plans make it otherwise!

Multiple telephonic conversations, multiple letters with relevant documents are a part and parcel of securing prior authorization. It is an expensive approach that is delaying the process of a true shift to value based care!

The Sunknowledge Approach in Prior Authorization

Sunknowledge Services Inc is a complete revenue cycle management company. We understand your practice management priorities better than anyone else. We provide you a complete support for all your prior authorization challenges by working as your reliable operational extension. Our team is well versed with all practice management/billing software in the marketplace.

Right from gathering of procedural information, contacting the physician office for documents, follow up on status , payer side communication, collecting the additional documents, updating the auth outcome in the billing system of the client, we are your one stop destination. Let us share with your our best practices, we provide stand alone prior authorization support!