The burdens associated with getting prior authorizations are widely acknowledged. It regularly leads to delays in patient care, prescription abandonment, and burnout among physicians.

Healthcare organizations, irrespective of their size, specialize in delivering medical care. To develop competencies in non-clinical admin functions, HCPs have to divert a certain amount of time, money, and resources towards it.

Until recently this was a viable alternative. Hiring a team to manage PA requirements in-house was feasible because healthcare profit margins were sufficient to cover lower reimbursements on some bills.

Also, healthcare payroll costs were not as high as they are now. And so maintaining an in-house team for prior auth requests has become quite expensive. So much so, that most small & medium-sized practices can’t afford to hire staff exclusively for authorizations.

But as with most problems, there is a solution to this one too. Healthcare organizations, especially independent and private practices, are finding more value in outsourcing their authorization requirements to professional prior authorization services. This is primarily because these service providers specialize in connecting with insurers and securing pre authorizations quickly.

While there are many reasons why healthcare prior authorization services are more efficient than in-house teams, for the purposes of this blog, we will only discuss the top reasons that make them better than in-house PA teams. Let’s start.

  • Knowledge and understanding of insurer policies and reimbursement guidelines
  • Experience in securing authorization for a wide range of medical services and procedure
  • Certified prior authorization specialists experienced in securing authorizations for multiple specialties
  • Prior authorization services provide FTEs at a fixed per-hour cost, resulting in an 80% cost reduction
  • Better turnaround time and fewer rejections resulting from experience in working with multiple providers and payers across various states in the US
  • Sound understanding of documentation and medical necessity requirements ensuring accurate submission of PA requests every time
  • Access to detailed and case-specific SOPs that help process and submit authorization requests accurately, even for difficult or commonly rejected medical procedures like imaging services.

With in-house teams, healthcare providers have to shoulder the burden of hiring, training, and maintaining PA specialists. However, by partnering with a prior authorization service they can avoid all these challenges and their associated costs.

To find out more about the benefits, features, and cost of outsourcing PA ops to prior authorization services, please contact Sunknowledge Services Inc., a HIPAA compliant revenue cycle management organization serving US healthcare providers and payers since 2007.

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