Prior authorization is a requirement that a physician needs to get approval from a health care provider before prescribing any medication or performing any operation. If the physician does not obtain this prior approval, the health insurance provider will not pay for any medications or procedures, which will leave the patient with a bill. This authorization is necessary because it makes sure that the service or the drug being requested by the patient is absolutely necessary.
Prior authorizations are also necessary because certain medications could dangerously interact with other medicines a patient may be taking. Some can be addictive as well, which is why authorization must be obtained.
However, getting this prior authorization can be quite taxing for the physician since it is a very lengthy process. In addition to taking time to get the approval, it can often delay those patients from getting the care they need. Patients also start getting frustrated when it takes longer to receive their prescriptions. It takes almost ten days to get prior authorization because providers have to call insurance companies where there is a lot of back and forth and of course waiting.
To patients with terminally ill diseases such as cancer, it is a very long time to wait. But there are ways in which this process can be speeded up and be made more efficient. Here are a few strategies that will save time:
The most important thing to do is to put the right person in charge. Having less experienced people handle prior authorizations can take up a lot of time. Someone who handles it should be savvy to speed up the process.
Even today, with technology getting so advanced, many prior authorizations are done through telephone or fax machines. The more efficient thing to do is to use the payer’s website for authorization requests. Doing this online saves hours of dead time on the phone.
Reassessing insurers is another way to speed up the process. If they are troublesome, the right thing to do is to cut them out. Some softwares can help determine which insurers take the longest to respond to prior authorization requests. So, it is more sensible to find efficient insurers.
Centralized staffing helps get rid of any redundant staff. This is because if a practice has various offices in different locations, it is more advantageous to designate a couple of employees to look after all prior authorizations. Another thing that a medical practice can benefit from is centralizing the staff so that the prior authorization staffers will know the insurers well. They will become much more specialized in the job, which will speed up the process even more.
Negotiating with the insurers can ease up the process even more. Proposing pre-approval deals with insurers is a great way to avoid lengthy prior authorization. For instance, let them know in advance that if a patient has a specific disease, what steps the practice will take. Creating these condition-specific plans in advance eliminates waiting time for approval and helps treat patients faster.