Understanding common Prior Authorization roadblocks
Prior Authorization (also referred to as ‘pre-certification’ or ‘prior certification’) may sound like a simple-enough process for those who are yet to have a firsthand experience of it. Stated in simple terms, it is a method of obtaining a formal confirmation from a patient’s health plan that a prescribed medication or procedure will be eventually covered by it. Failing to obtain Prior Authorization can lead to insurance payer refusing to pay for the cost incurred, and this, in turn, can imply that the cost be borne by the patient.
Prior Authorization, thus, is an important step in ensuring payment when a claim is finally submitted to the insurance company. However, simple as it may sound, the process is still ridden with antiquated practices such as filling out lengthy forms, making tedious phone calls and spending many long minutes to get the process completed. It’s no wonder that healthcare providers, upon whom the responsibility of obtaining this critical approval primarily rests, look upon the process with a certain amount of dread and apprehension. Prior Authorization has earned for itself quite a bit of notoriety as a major time-waster for busy practices, taking away precious hours from the time that could have been spent in actual patient care or other more important matters.
A step to quicken the pace
In the face of such challenges, healthcare providers of all shapes and sizes are eagerly seeking out professional assistance to help ease the Prior Authorization burden. A dependable source of such support can be found in the specialized billing service providers, operating from different locations around the globe on a remote support mode. They are being increasingly engaged by a rapidly growing number of healthcare practices in the U.S. chiefly for the professional assistance they provide in easing the Prior Authorization burden at a cost that is surprisingly affordable.
Strategic outsourcing of key business tasks can do wonders in improving the overall efficiency of the revenue generating process. The biggest advantage of outsourcing, however, is getting an instantaneous access to a vast pool of dedicated billers, coders and other revenue cycle management personnel, without having to scour the employment market to find the right people to work for you. The onus of training these personnel, providing them with the necessary infrastructure, and of being fully responsible for the best quality output, lies fully with these billing service providers. With such excellent assurances, healthcare providers are confidently entrusting their billing tasks to these trained hands and having more time to focus on patient care.