Prior authorization is imposing a serious burden on healthcare providers. Insurance companies actually use PA’s to address any inappropriate variations in care and prescription. Most often it covers expensive medications.
To cite an example, we take the case of a large academic department which is spanning across 11 locations in Utah which had median administrative cost per PA of $6.72 overall, $15.80 for biologics and had most PA’s approved subsequently.
Prior authorization especially for PART B drugs are a critical source of differentiation in coverage policies between privately and government administered Medicare. Hence it is quite clear that prior authorization services are still a huge headache for healthcare practices. Although there have been substantial changes in the increased use of technology in prior authorization by the AMA especially over the past one year and half, there is still a lot to be done.
A recent survey done by the AMA which was done the last December concluded that almost 94% of the physicians have experienced care delays while waiting for a health insurance company to authorize care while 79% reported that patients actually called of their treatment. Also, 30% conveyed that requirements with prior authorization have led to adverse effects with patients.
The Sunknowledge action plan
If you are looking for a serious partner that can help you at these crunch times of labor shortage, work with us. We are currently working with some of the largest providers of the country and have great references from the best. Our team knows how to reduce operational costs by 70% with our knowledge of working at the front end.
We know how to work on your eligibilities, following up with the physicians for important documents, working with the insurance companies, updating the auth outcome in the PM system of the client. Our versatility, ability to work as a top class extension makes us a quality RCM services company. Looking to know more on how we do it, speak to us now. We have worked with the best and have eliminated proven process loopholes with our specialized presence.