Prior authorization is one of the most exhausting and difficult components in the entire revenue cycle. It can interrupt workflows, tie down in-house resources, and cause severe disruptions to the medical billing process. It is also a time-consuming process that can take away precious hours from your schedules. Prior authorization issues are associated with 92 percent of care delays and may also contribute to patient safety concerns as well as administrative inefficiencies.

Considering the current scenario, Prior authorization is overused and the existing processes are too difficult. Due to its widespread usage and the significant administrative and clinical concerns it can present, prior authorization is a challenge that needs to be addressed through a multifaceted approach to reduce burdens on physicians and patients.

The inefficiency and lack of transparency associated with prior authorization cost physician practices time and money. The lengthy processes may also have negative consequences for patient outcomes when treatment is delayed. In the current managed care environment, an increasing number of prescriptions are being denied by plans, requiring prescribers to complete prior authorizations. This process is highly disruptive, time consuming, and often leads to denial without any relevant clinical review.

Here are some key challenges faced in Prior Authorization:-

  • Prior authorization issues are associated with 92 percent of care delays and may also contribute to patient safety concerns as well as administrative inefficiencies
  • Prior authorization process can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care
  • 64%of providers reported waiting for at least one business day for a prior authorization request and 30% waited for at least three business days
  • 78%of providers reported that long prior authorization processes are linked to patients abandoning their treatments
  • Providers take 14.6 hours on an average to complete these requests, which is the equivalent of two business days. 34% percent of providers have staff dedicated exclusively to complete prior authorizations

Services requiring Prior Authorization:-

  • Therapy (speech, occupational, and physical)
  • Plastic Surgery
  • Durable Medical Equipment (DME)
  • Inpatient
  • Home-Based Services
  • Pharmacy and Medications
  • Pain Management
  • Advanced Outpatient Imaging Services
  • Services Requiring Notifications (All newborn deliveries-Maternity obstetrical services, outpatient care, etc.)

Prior Authorization – Process 

Viaante is a HIPAA compliant Healthcare Service Provider offering quality and customized services, which helps the healthcare firms in improving business process efficiencies, deliver superior customer service experience and boost their financial performance. Viaante has years of experience and expertise in delivering accurate, high quality, cost-efficient and streamlined RCM services that boost up the performance of the organization. Viaante is committed to simplify the Prior Authorization process and deliver the results you seek in the shortest possible time.

Outsource Prior Authorization services to Viaante in order to achieve:-

  • Guaranteed reduction of operational cost by 70%
  • Prompt Service with a accuracy rate of 99%
  • Durable Medical Equipment (DME)
  • Increase your current production rate by 1.5-2.x
  • We are flexible and are in all spaces of RCM