Prior Authorization

The prior authorization process can be maddening. So many forms to fill out, faxes to send, phone numbers to track down and portals to navigate though can make an already daunting task a nightmare for busy practices. According to the American Medical Association, over 64% of physicians report they experience long wait times in waiting for PA’s to come through, which ultimately has a negative impact on their already frustrated patients. These time-sensitive, heavily manual tasks can take a healthcare provider up to two hours on the phone. PA’s can also require full time staff in a busy specialty office where PA’s aren’t as straightforward. Infusion therapy PA’s are known to be consistently difficult due to the high-cost of treatment. So, how can the process of achieving prior authorizations be easier and faster? We’ve put together our top 4 tips to help you out.

  1. Understand the Prior Authorization Process. First and foremost, it’s critical for those staff members performing prior auth’s to understand the process and the players involved in obtaining approval. Gathering this knowledge can take up a lot of the practice’s time initially but can improve compliance and increase approval rates significantly. You’ve heard the sayings “Knowledge is power”, right? The more healthcare providers and physicians know about the process going in, the more they can prepare for roadblocks and how to handle them. Even better, the practice can hire a prior authorization specialist who is  familiar with the nuances involved in obtaining the approvals.
  1. Embrace technology. Streamlining the manual workflow process with automation can be a true game-changer for practices and their patients. These PA’s have the reputation of being insanely tricky with multiple steps and can take weeks. Implementing a software that is easy to use and focuses on the specific steps involved in the medical benefits PA process can take hours of work off practice staff and allow patients the ability start treatment 7-10 days faster. No more rooting around for the proper forms and where to send them. Digital versions of the right form, from the right payer, can get you the right information needed, every time. If you choose the right PA solution, it can also eliminate the need to visit multiple product and payer portals and will only require one single-source login. How cool is that?
  1. Have accurate documentation. If you haven’t yet pulled the trigger on implementing technology into your practice/patient workflow, then you should shift your focus to taking insanely accurate notes. Digital solutions with a strong user experience will intuitively prompt you for this information and collect vital information such as dates, and PA checklists for you. If you are still managing this process manually, you’ll have to rely on your own note-taking skills.  Accurate documentation can help you achieve less denials but will require a robust step-by-step manual checklist that your team will need to follow closely to ensure steps in the process aren’t skipped. 
  1. Educate the patient on their role in the PA process. In the specialty healthcare medication ecosystem, the goal of all players is to provide the best possible care to patients. Patients need to realize they have a role in their treatment plan as well. Not just from an adherence perspective, but also from their willingness to be open and work with the practice and payer by providing any information they might need in a timely manner. Patients should double check their policies and understand their medical benefits so they have an idea of what they can expect going into treatment. The practice will generally make every effort they can to aid the patient in obtaining financial assistance for the prescribed drug, but it is ultimately the patient’s responsibility to have an idea of what their benefits include and what their out-of-pocket expenses will be. This open communication between patient, practice and payer is sure to help the patient achieve a higher rate of success.

The prior authorization process is long, time consuming and tedious. Want to know more about how to streamline the process and cut back on mundane day-to-day tasks? Talk to one of our practice consultants and we can show you how to start the process. Did we mention that eBlu Solutions is no cost to you?  Our purpose here at eBlu Solutions is to support the process for patient access to the treatments they need for a healthy life. Let us show you how. Contact us today.

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