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Remedy for the Pre-Authorization Predicament


Physicians are required to face several frustrations in providing care to patients, but prior authorization happens to be the most infuriating and expensive one. It costs heavily to fight with payers over prior authorizations and precious time is lost, bringing down productivity. The silver lining is that there are effective ways for improving the situation.

Significance of Prior Authorization in the Medical Industry

Legal requirements demand that health care providers obtain approval from health insurance providers for providing specific medical services to patients. Aimed at minimizing care costs, this ensures that benefits are payable only if the care-related processes get pre-approval from the insurance company.

If not handled effectively, prior authorization may prove to be an impediment to providing quality care to patients. They may lead to loss of hefty sums of money and precious hours of lost productivity. While prior authorization is about ensuring patient safety and care efficacy from the payers’ perspective, it is a hindrance that costs time and money to physicians and practices.

Why is Prior Authorization Dreaded?

The prior authorization process being very arduous, several physicians just give in. Insurance companies save money from prior authorization. The ultimate result is that the health care system loses a considerable amount of money due to this. Practices and providers can very well use the time and resources spent on their prior authorization tasks on patient care that is more important.

How to Resolve the Prior Authorization Conundrum?

One way of minimizing the costs and hardship of prior authorization is finding out well in advance what documentation or information a payer would need.

Making use of technology helps practices in reducing the prior authorization burden. Electronic health record software proves to be an effective tool in this regard.

Payer companies may use websites for expediting the prior authorization process. Individual practices can develop unique techniques in this regard according to their own experiences and requirements.

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