Reducing the Burden of Prior Authorizations: Expert Solutions for Medical Practice

According to the American Medical Association, most medical practices spend an average of 16.4 hours per week handling prior authorizations. That’s over two full working days each month dedicated to navigating a complex and often frustrating process.

Getting approval from insurance companies before delivering treatments or medications is often a tedious process. While prior authorizations are intended to control costs and ensure appropriate care, they can create significant delays and extra work for medical staff.

Today, prior authorizations have become one of healthcare’s most taxing administrative tasks, stressing the importance of finding efficient solutions to these hurdles. When your staff spends less time on paperwork, they can dedicate more energy to what matters most—providing excellent care and service to your patients.

Many practices have switched to remote staffing to address these challenges effectively. At DrCatalyst, our remote authorization coordinators are experts in handling prior authorizations, eliminating 90–95% of authorization work for our partner practices. Let us take care of the endless faxes, phone calls, and follow-ups so you can focus on what really matters: your patients.

Reclaim Your Time and Transform Care

What Are Prior Authorizations?

Prior authorization is a process where healthcare providers must acquire approval from the patient’s insurance provider before performing a medical procedure or prescribing certain medications or treatments. This approval ensures that the proposed care is covered under the patient’s insurance plan and is deemed medically necessary.

Why Are Prior Authorizations Required?

• Cost Control: By ensuring that treatments are necessary and cost-effective, prior authorizations help control healthcare costs.
• Appropriate Care: Prior authorizations help in verifying that the prescribed treatment is appropriate for the patient’s condition.
• Prevention of Misuse and Abuse: Prior authorizations in healthcare help prevent fraudulent or unnecessary claims by ensuring that treatments and procedures are legitimate and justified.
• Verification of Medical Necessity: This process confirms that prescribed treatments are necessary for the patient’s condition, preventing unnecessary procedures.

While requirements can vary by insurance provider, several common types of procedures often need prior authorization:

• Surgeries: Joint replacements, spinal surgeries, and bariatric procedures

• Specialist Visits: Specialists such as cardiologists, neurologists, or oncologists

• Diagnostic Tests: MRIs, CT scans, and PET scans

• Hospital Stays: Planned hospital admissions and certain outpatient procedures

• Medications: Expensive or specialty medications, including biologics and certain injectables

• D.M.E.P.O.S: Items like wheelchairs, CPAP machines, and prosthetics

• Therapies: Physical therapy, occupational therapy, and speech therapy sessions

• Mental Health Services: Certain mental health treatments, including inpatient psychiatric care and specialized therapies

• Procedures with High Costs: Advanced or specialized procedures that cost significantly more than the usual

Understanding the intricacies of prior authorizations is the first step toward managing and reducing the burden. By addressing these challenges, medical practices can operate more efficiently and improve patient satisfaction.

The Challenges of Prior Authorizations

While prior authorizations are meant to control costs and ensure appropriate care, several challenges make them a significant burden for medical practices.

• Complex Requirements: Different insurance companies have varying and often complicated requirements.

• Frequent Changes: Policies and approval criteria change frequently, adding complexity.

• Manual Processes: Many authorizations still require time-consuming phone calls, faxes, and paperwork.

• Resource Intensive: Dedicated staff are needed to handle the administrative workload.

• Unclear Criteria: Lack of clear guidelines from insurers makes it hard to know what’s needed for approval.

• Denials Without Explanation: Requests can be denied without detailed reasons, complicating resubmissions.

• Coordination Issues: Effective authorization requires coordination between multiple departments.

• Communication Delays: Slow communication between providers and insurers delays the process.

• Impact on Patient Care: Treatment delays negatively affect patient health and satisfaction.

• Financial Burden: Administrative work increases operational costs and can lead to lost revenue.

Addressing these issues can help medical practices save time, reduce costs, and improve the overall patient experience.

Expert Solutions to Reduce the Burden

Addressing the challenges of prior authorizations requires practical, effective solutions. Here are ten expert recommendations to help reduce the burden:

• Implement Automated Systems: Use technology like electronic prior authorization solutions to automate the process, reducing manual work and speeding up approval times.

• Outsource Prior Authorizations: Partner with third-party staffing providers (such as DrCatalyst with its remote prior authorization specialists) to handle your processes, freeing up staff to focus on patient care.

• Invest in Staff Training: Undergoing regular training, as DrCatalyst’s staff does, ensures familiarity with the latest requirements and best practices, leading to more efficient and accurate handling of prior authorizations.

• Enhance EHR and Practice Management Software: Utilize software with built-in prior authorization capabilities to manage and track requests more effectively.

• Establish Clear Communication Channels: Develop strong relationships and communication protocols with insurance companies to resolve issues quickly.

• Utilize Predictive Analytics: Use data analytics to predict and prepare for common prior authorization requirements, reducing delays.

• Standardize Documentation: Create standardized templates and checklists for prior authorization submissions to ensure they include all necessary information.

• Advocate for Policy Changes: Work with professional organizations to advocate for simplified prior authorization processes and better regulatory policies.

• Implement a Dedicated Authorization Team: Create a specialized team within your practice to handle prior authorizations, ensuring consistent and expert handling of requests.

These solutions can significantly ease the burden of prior authorization, allowing medical practices to operate more efficiently and focus on delivering high-quality patient care.

Prior Authorization Relief with DrCatalyst

Handling prior authorizations significantly drains your practice’s time and resources. The hours spent on paperwork and chasing approvals could be better utilized in providing patient care, improving outcomes, and growing your practice.

Recognizing this urgent need, DrCatalyst steps in to offer a solution tailored to your practice’s specific challenges. With DrCatalyst’s remote prior authorization solutions, you gain a dedicated team of experts who specialize in streamlining this process. Here’s what you can expect:

• Expertise in Prior Authorization Processes:
  Our remote coordinators expertly handle complex insurance requirements, ensuring your practice’s compliance and smooth operations.

• Streamlined Operations:
  By managing the intricacies of prior authorizations, we allow your staff to dedicate more time to patient care and other critical tasks.

• Improved Financial Performance:
  Our services optimize prior authorization workflows, reducing unnecessary expenses and bolstering your practice’s financial health.

• Time Savings:
  We take on the labor-intensive tasks associated with prior authorizations, allowing your team to focus on delivering quality patient care.

• Cost-Efficiency:
  Our services can lead to significant savings for your practice. One of our partners saves an average of $25,000 annually with just one remote staff member

• Expert Support:
  Our trained coordinators ensure that your practice navigates insurance requirements with ease, maintaining compliance and efficiency.

These results demonstrate how DrCatalyst’s prior authorization solutions can transform your practice operations. By entrusting us with the paperwork and other administrative tasks, various medical practices now enjoy the freedom to deliver compassionate, uninterrupted patient care, assured that DrCatalyst is taking care of the rest.

Make the change today and experience the difference in practice efficiency and patient satisfaction.

Optimize Authorizations with DrCatalyst