Precertifications required by healthcare professionals take up a lot of their working time. The prior authorization process, although created to check for unnecessary procedures, is now a reason causing burnouts in physicians. They're a necessary precaution but they cost the organization both time and money.
The Main Problem with Prior AuthorizationInsurance companies require prior authorizations from healthcare professionals before the physician can begin treatment. More and more so, these authorizations are now required for routine, low-cost treatments, thereby increasing the burden on physicians. A significant number of healthcare professionals have started to find practicing medicine tedious because of this reason. They find it to be one of the most frustrating parts of their career in medicine. Prior authorizations also cost healthcare providers a lot of money and resources. Physicians spend over 14 hours a week each with insurance providers working with prior authorizations. A lot of time is also spent verifying whether or not the authorization is required in the first place. Organizations have had to hire full-time employees that solely handle interactions with insurance companies, which again, costs them more than $80,000 per physician annually.
The History of Prior AuthorizationsHealth insurance for employees became prevalent by 1950s. The access to healthcare increased, and because of that the cost of healthcare rose as well. Necessity-checks started soon after to reduce cost and avoid unnecessary treatments. This job was taken up by the physicians themselves because there were no other resources available. This is where insurance providers stepped in. They were highly invested in reigning in the cost, therefore it served both the physician and the insurer's purpose. Over time, insurance companies multiplied substantially, which only complicated their review processes. What started out as a simple way to reduce unnecessary cost and treatment in patients has now resulted in delaying healthcare to the ones in need.
Managing Prior AuthorizationsCurrently, various health plan web portals are the most widely used methods of submitting prior authorizations. These take anywhere between one to three business days to get a response. Due to their time-consuming nature, organizations are now shifting to fully electronic methods. Electronic transactions are the fastest way to complete prior authorizations because they are instantaneous. It increases efficiency when both payer and physician transact electronically. Automation of prior authorization leads to a faster response generation, which in turn would help healthcare professionals give timely care to their patients. This is also a great way to save both money and time, on both ends, and relieve the burden of prior authorizations. There are many vendors that provide automated, integrated solutions to manage prior authorizations. They eliminate a large amount of work from the organization's end. The best electronic health record (EHR) keeper would be one that constantly learns from the available network and applies the knowledge to similar cases. It should be fully transparent, and wholly integrated with the revenue cycle. A good EHR vendor also provides full-service support by offering clinically trained experts that assist with the documentation process and approval of requests.
Key Takeaways from 'Prior authorizations: relieving the burden':
- Prior authorizations are required by healthcare professionals before they can provide care to patients. This means insurance companies have to approve their authorization request before a physician can begin treatment
- Prior authorization is a time-consuming and exhausting process, and it contributes to a physician's burnout. It also leads to delay in care for the patients
- Prior authorizations began as a means to check if there were unnecessary treatments taking place in the healthcare industry. They were a way to reduce cost and improve effective treatments. With the increase in number of insurance providers and constantly evolving reviews, these checks have become more restrictive and costly
- Automation of prior authorizations from both the payer and healthcare system's end will significantly reduce the burden on the physicians as well as be time and cost-effective