Time and Money Burdens with Prior Authorization: Know Your Practice Management Priorities

Prior Authorization

Almost 37 times in a week! If you are a physician and recently surveyed by the AMA, 37 may be the number of prior authorization requests that you and your administrative staffs complete each week. It is quite remarkable amidst many other stats that clearly suggest the overburdening nature of the prior authorization process.

Prior authorization is supposed to be shield for the patient with drug abuse and malpractices with medical procedure. However, the number of prescription delays and abandonment of procedures take a huge toll on a patient looking for prompt treatment.

There’s More to It

Based on a web based survey of only 1000 physicians, 37 is just an average number based on the survey and there is more. Almost 75% claimed that handling all those requests translates into a high burden for the physicians. For just completing prior authorization requirements, an average of 16.4 hours is spent each week to get the medicines to the patients, the services, and procedure that they need. On an annual basis, that amounts to nearly 853 hours consumed by the prior authorization tasks! The burden of prior authorization is so great that almost one third of the physicians have staffs that work solely on it!

PA Average Wait Time is Killing

Question was asked to the practices on how long they had to wait on an average for a PA decision. The collated answer was; almost 60% reported for waiting for at least one business day while 26% reporting to wait for at least three business days. But the number was almost 90, as almost all agreed that inefficiency in the prior authorization process delays patient access to necessary care. Nearly 40% decided that “often or always”, prior authorization requests hold up the care.

While several states have already passed legislations, Delaware and Ohio being the recent, to protect patients from over burdening utilization management requirements; as a practice it is imperative for you to set the right foundation, and lay down the right checks and balances that betters your prior authorization demands in the best possible manner.

The Sunknowledge Botox Prior Authorization Approach

We worked with one of our clients in Botox, primarily a medication needed with cosmetic purposes. Our persistence, proactive persuasion with our extensive knowledge of the payer protocols, and Knowledge of the Rx caveat yielded better results while implementing a strong financial performance with less administrative hassles. As it required more effort than any other case involving conventional medication process, we completed all the tasks with:

♦ Verifying eligibility
♦ Initiating authorization
♦ Following up on the request
♦ Obtaining and acknowledging authorization
♦ Scheduling the drug delivery

We provide you complete transparency and accountability with gathering of procedural information from provider and patient, determining the eligibility coverage, validate and initiate PA request with proactive payer communication, follow up with ordering physicians for additional and relevant documents, checking the auth status, and updating the outcome in the PM/billing system.

Our simple processes guarantee you fast and proactive prior authorization support with 100% accuracy and at just $5 per auth! Contact our experts to gain knowledge about our functional best practices. We are your one-stop destination for all prior authorization needs.


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