Payers get the upper hand because they are huge companies that can funnel resources into figuring out how not to reimburse you. Their most recent shell game is prior authorization.
“When I started out [prior authorization] never came up,” says Kevin de Regnier, an osteopath who has practiced for more than 25 years. “Then we started seeing it in a small number of high-dollar medications, then it expanded into more and more branded medications, and then moved into getting procedural prior authorizations, especially in the radiology field. Now you’ve got to prior auth for every procedure and every referral, even referrals for physical therapy.”
It may feel like you’re the only physician or practice manager who spends the bulk of your day on the phone justifying procedures and medications, but you’re not alone. In 2016, the American Medical Association conducted a survey of member physicians to assess their prior authorization experience.
The results were striking: 75 percent of respondents called their administrative burden “high.” No wonder, when they averaged 37 prior authorization requests per week with an estimated 16 hours spent weekly on those requests. As a result, one-third of the physicians hired a staff member whose only job was handling prior authorizations.
“Because of the number of things that authorizations are being required for, I know an eight-doctor group that has a staff member who spends 80 percent of their time just doing prior authorizations for tests,” says Jill Young of Young Medical Consulting.
Win the Prior Authorization Game
Despite the pain of prior authorization, your practice can take concrete steps to make the process more efficient.
This step eliminates the dreaded wait time on hold that is the bane of every medical practice. Even if using the online option only slightly reduces the time needed to hear back from an insurer, it saves hours of dead time on the telephone.
Creating condition-specific plans of care in advance lets you focus on what you do best: treating your patients, not waiting for the go-ahead from a far-off insurer.
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