Positive Reforms are The Need of The Hour with Prior Authorization Pains

Prior Authorization
Replacement of Affordable Care Act (ACA), the proposed MacArthur Amendment, does not actually address the well-established practice of the health insurer in use of restrictive prior authorization requirements.

While prior authorization is essentially a check that is run by the insurance companies and even the third party payers for approving the treatment, medications, procedure for the individual patients, we see additional suffering especially with terminally ill patients in receiving timely access to medication.

Electronic prior authorization not only reduces the hard work involved but also makes the patients happier. It is possible to receive a prescription and get it approved before leaving the physician office. Currently, we find practices spending a lot of time and money on all kinds of prior authorization that includes the preapproval of the prescriptions.

Recent studies suggest that prior authorization takes up an average of 1.1 hours per week for primary care physicians, 0.8 hours per week for medical specialists, and 0.7 hours per week for surgeons. It should be noted that time devoted to formularies are not included. Facts also suggest that primary care nurses spend 13. 1 hour per physician on a week on prior authorization and almost 3.8 hours per week on the formularies.

Almost 90% of the prior authorization requires a fax or a phone call with costs of completing these requests at between $2000 and $14000 per year/per physician. Prior authorizations are almost 2% to 4% of the prescriptions and considering the billions of prescriptions ordered yearly, a great deal of extra work and money gets used up. Practices lack the time to focus on a patient-centric model.

The Sunknowledge edge

A complete medical billing and collections company, Sunknowledge services Inc provide end to end practice management assistance. Combining state of the art processes with expert resources, we believe in working as your ideal operational extension. Laying down the right checks and balances, we better your reimbursements, improve your denial management attributes in the long run. We cover

♦ Gather vital information on the medical procedure, patient, and provider
♦ Verify and validate prior auth request with effective payer side communication
♦ Check the patient’s eligibility
♦ Initiate the auth request based on the payer mandates
♦ Checking the auth status
♦ Collating relevant documents from the ordering physicians/follow up

We provide our standalone assistance in prior authorization without any training, installation or transaction charges. Our experts are ready to provide you a complete demonstration of our best practices. Partner with Sunknowledge and experience the difference we bring to the table.

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