Outsourcing your prior authorizations process can help you reduce denials, save time and money, minimize data errors, and improve patient care.
Prior authorization is a process by which healthcare providers must qualify for possible payment coverage. This is done by obtaining advanced approval from a health plan before a specific service is delivered to a patient. However, pre-authorizations (PAs) are labor-intensive for healthcare providers, staff, and patients.
According to the American Medical Association (AMA), prior authorization is overused, and existing processes present significant administrative and clinical concerns.
Therefore, outsourcing your prior authorization process can help your practice focus on patient care. It will also allow a trusted partner to manage the process with high-quality standards while relieving your staff from the administrative burden.
Therefore, here are some reasons why you should consider outsourcing your pre-authorization process:
- Reduce denials: There are various reasons for prior authorization denials such as errors, coverage issues, or failure to follow the steps required by the health plan. Reduce denials by ensuring all patients coming for network or out-of-network visits, advanced diagnostic, or elective procedures have proper pre-authorizations.
- Save time and money: According to an AMA survey data, physicians and their staff spend an average of almost two business days (13 hours) each week completing prior authorizations. In this same survey, 88% of physicians describe the burden associated with PAs as high or extremely high. Outsourcing this process frees up time for your staff and saves costs for your medical practice.
- Minimize data errors: A trustworthy outsourcing partner will be aware of guidelines and industry changes. This helps you ensure that you complete this process correctly and in compliance with insurance providers. They can help you collect patient information from your provider’s clinical documentation. Medical practices must use this information to obtain prior authorization for inpatient and outpatient procedures that require it.
- Improve patient care: Based on a recent AMA survey, prior authorization continues interfering with patient care and can lead to adverse clinical consequences. Based on that study, 34% of physicians report that PAs, or the lack of them, have led to a serious adverse event for a patient in their care. Reduce your staff’s burden from doing prior authorizations so they can focus on what matters the most: your patients!
Let us know how we can help!
Health Prime offers Prime Authorization, our optimized Virtual Office solution that helps with prior authorization or pre-certification of services you render. We can obtain the precertification/prior authorization of services for a patient and process it if we have all the proper documentation from the practice and provider.
Proper documentation for this process consists of a completed and signed medical record with:
- The test or procedure order listed along with the body part.
- CPT code or specific procedure ordered.
- The ICD10 code.
- Any previous treatments or medications tried.
Outsourcing your prior authorization process helps medical practices focus on patient care and allows us to gather, filter, report, and manage your process unbiasedly. We also stay updated on changing government regulations, so your practice doesn’t have to worry about authorization compliance issues.
If you want to know more about outsourcing your authorization processes, contact us at [email protected]. Let’s discuss how we can help you return to what matters the most: your patients.
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