EPA: Getting Help through Prior Authorization Services

The concept of prior authorization was thought to address the few grey areas of healthcare. One of the areas that were targeted was the uncontrollable rise in the cost of drugs and medication. In order to curb the illegal practice and enable a seamless transition between the insurance company and the patients, prior authorizations soon became the instrument to seek for.

Since the prime focus was on reducing the time spent between searching medical record l and prescription delivery, Electronic Prior Authorization (EPA) replaced the error-prone and cumbersome paperwork process. The EPA has prioritized mobile health (mHealth) and health IT making the process to obtain the doctors’ confirmation on drug eligibility much faster, helping to speed-up the overall treatment process. The worrying fact is the associated issues that EPA brought in have been surfaced during the recent surveys that highlight some alarming statistics:

• Approximately 94% of medical practice managers opine prior authorization is hugely time-consuming.
• Approximately 70% of the denied prior authorizations are caused by incomplete information and lack of proper or no clinical review.
• Approximately 4.6 hours each week on an average is spent by the physicians’ office, just on prior authorizations.

Delved deeper, it was found that it’s not EPA as a process is not to be blamed but the way it is being performed by the in-house staffs or rather their inability to work on the online prior authorization platforms. It has come as a specialized job for them, a burden besides carrying out their other routine work. To combat this drawback, many medical and healthcare service providers are opting to outsource the EPA process to professional prior authorization services. This change is helping them to address the issues in broader aspects like:

Labor charges

The burden of labor costs can be reduced by assigning an expert to look after the EPA process. The data processing can be costly with the involvement of the healthcare staffing, hours spent, and the required cost of training. Leading prior authorization services like PriorAuth Online provide service for charges at a very low per auth based price making it easy for the providers find to save a huge amount.

Delays in approvals and denials

The internal staff's inept handling of prior authorization lead to the denials, the biggest worry. Improper handing often leads to delays in getting the authorization for the requests that leaves both the patients and the providers frustrated. Patients getting delayed in starting the treatment can prove costly in critical situations. It is painful for the providers too, risking their patient care and revenue initiation factors. Addressing these problem areas, professional PA handlers leverage their strategy of company protocols, follow-up scheduling, application of correct codes, and focusing on the expected timeline.

Standard compliant

The electronic prior auth process has a lot of protocols and compliance to follow. Shifting to an EPA system addresses most of these problems, more because the professional PA services maintain strict protocols to adhere to the compliance standards like HIPAA and HITECH helping the practice meet the compliance standards.

Apart from these basic advantages, experienced electronic prior authorization services help you to streamline your practice in a comprehensive way through RCM and practice management solutions.