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The Persistent Difficulties with Prior Authorization

Beginning with the onset of the pandemic, through its ruthless domination for almost two years and finally, having started to crawl through a process of gradual recovery, healthcare practices across the USA have gone through many challenges. They had to face difficulties of various natures, ranging from issues such as shortage of skilled labor, to increased cost of operations, to problems pertaining to supply and delivery. However, the one common issue that has impacted all healthcare practices, is the ongoing need to cope with prior authorization requirements.

Prior authorization requirements, as dictated by different payers, have always eaten into the time and effort of healthcare practices, often leaving them breathless by their stringent demands. In a recent survey conducted by Medical Group Management Association (MGMA), various medical groups were asked about how prior authorization requirements have changed in the past 12 months. 644 responses were received and analyzed. 79% of those surveyed reported that prior authorization requirements have increased over the last one year. About 19% responded that they have stayed the same. Only 2% was found to have remarked that the requirements have decreased.

The Path to Better Efficiency

The debate over the need for prior authorization services continues to rage. The demand for reducing its burden continues to get voiced from all quarters of the provider space. But till a mutually satisfactory resolution is reached, healthcare practices will just have to learn to live with prior authorization requirements.

Under such circumstances, it’s no wonder that a large (and growing) number of such practices are outsourcing their prior authorization requirements to dedicated third-party service providers. One instant benefit that is achieved through such a migration is the amount of time and in-house resources it frees up for them. In many cases, the preference is for prior authorization service providers located at an offshore location. The reason for this is the distinct cost advantage that they bring with them. On the whole, these agencies use experienced and well-trained personnel to manage all prior auth requests on behalf of their clients, taking care of all the calls, faxes or electronic PA requests that need to be made in order to obtain the requisite authorization. With their professional and streamlined intervention, the results are a reduced rate of denials, a greater number of prior auth requests getting handled in unit time and an overall increase in collections.


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