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Coming to terms with Prior Authorization

It is common practice in the modern world to outsource Prior Authorization to third-party billing partners. The merits of such a strategy, however, remain a matter of debate. While many providers act jubilant about the decision and are strongly of the conviction that it has improved the efficiency of their Prior Authorization efforts, some others continue to remain doubtful. Even if opinions seem divided, what is the verdict of the majority? Let’s find out.

One of the chief complaints about Prior Authorization is the amount of time it takes to get completed, or the amount of strain it puts on a healthcare facility’s billing resources. Indeed, it is a process that is still steeped in somewhat antiquated methods, involving a good deal of paperwork, sending faxes and making lengthy telephone calls. Surveys have revealed that on an average, a week’s volume of prior authorization work is almost equal to 2 business days’ time.

Prior authorization, let’s face it, is a tedious process, and unless one is familiar with payer norms and the various caveats of reimbursement, the efforts to get a prescribed drug or procedure prior authorized can end in failure. It needs, in short, expert handling with adequate knowledge. This is why many providers choose to appoint dedicated professionals to take care of all their prior auth tasks. But does it really help?

Does outsourcing prior authorization really help?

The short and simple answer to this question would be, yes. But there are a few conditions. Professional intervention can do wonders in improving the failing efficiency or poor outcome of any business process. Prior authorization is no exception to this rule. However, given the abundance of billing service providers in the market today and their widely uneven qualities, one should take one’s time to decide on which billing partner to work with.

In this respect, one should not shy away from making all necessary inquiries into the nature and extent of experience of a prospective partner in the area of work for which they are being considered, how satisfied its clients are, its accountability, transparency of operation, proof of expertise and so on. When one has checked all the boxes, it is wise to consider the financial aspect of the deal, such as pricing and other fees. The best names in the business do not come cheap, but can prove to extremely effective in helping a healthcare practice save hundreds of thousands in billing cost in the long run.

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