Shape of Things to Come

Electronic prior authorization cannot be rightly called a novelty anymore. Even though traditional methods for prior authorization are still in wide use, electronic prior authorization has already made its way into many healthcare practices across the country. The transition is happening at a moderate pace, but it is a steady movement. The reason why more and more healthcare practices are embracing electronic prior authorization is easy to understand. First, it dispenses with the need for tedious paperwork (such as filling paper forms or sending faxes, and in most cases, doing both), or making lengthy phone calls to the payor’s office. It also practically reduces the time needed to complete a typical prior auth request to a matter of a few minutes.

Getting Ready

In a recent development, the American Hospital Association (AHA) has voiced its support for electronic prior authorization processes but has also urged the Office of the National Coordinator for Health Information Technology (ONC) to fully develop and adequately test any initiative before making it mandatory for health systems to comply with a new regulation. The coming days, it is speculated, will witness more work being done in these directions, including a better integration with popular EHR (Electronic Health Records) systems in current use.

While the benefits of switching over to electronic prior authorization are many, a successful transition will invariably come with a fresh set of challenges. Chief among these will training existing personnel on how to initiate and complete electronic prior auths. What is feared that given the current shortage of skilled labor in the market in these post pandemic times, finding competent personnel may get tough.

A Simpler Solution

A highly viable and sustainable solution is to engage professional, third-party prior authorization experts to do the job. With their usually extensive experience with prior authorization tasks and their familiarity with different kinds of EHRs, dedicated medical billers are often the best choice to keep the prior auth burden off the shoulders, and also get things done faster and at a lower cost. Other benefits include a reduced rate of denials, a greater number of prior auth requests handled in unit time and an overall increase in collections. Simply put, it just might be the best option for healthcare practices who wish to save themselves the hassle of transitioning to a new mode of prior authorization.