In Prior Authorization

Prior authorization has become an increasingly time-consuming task, and the number of situations where it’s required before offering any treatment to patients is increasing as well.

This continuing trend results in most medical practices struggling to keep up with these increasing demands on practice staff. Ultimately, this leads to delays and incorrectly submitted prior authorizations, which can have frustrating and damaging effects on patients.

While there is no way around this mandatory process, there are options for streamlining administrative operations by using a pre-authorization service.

So How Long Does Prior Authorization Take for Medication?

Getting prior authorization for medication can take different amounts of time. It usually takes a few days to a week, but sometimes it might take longer. It depends on the type of medicine, the insurance company’s rules, and how quickly your doctor’s office can provide the needed information. For example, in May 2023, a medical practice in the United States had to make at least 3 calls to the insurance company for approvals on injections. (Facepalm)

Impacts Of Prior Authorization On The Patient Experience

We first want to highlight all the negative impacts of the prior authorization process on patient care and health.

Delayed Access To Treatments

The list of both inpatient and outpatient procedures that fall under the prior authorization process is constantly growing and changing. And this is happening at a pace that makes it difficult even to know whether a treatment falls into this category.

But even when you’re confident that you need to get pre-authorization, the manual process for your practice staff takes time. And because the forms and details regularly change as well, this often leads to delays. You might be able to obtain prior authorization within 24 hours.

But many medical practitioners experience much longer wait times before they can actually start treating their patients.

Delayed Access To Prescriptions

The pre-authorization process has also expanded into covering prescriptions. This mainly depends on the type of medication, the cost per prescription, and the total expected ongoing costs.

The frustrating thing for patients and doctors can be the delays that first come from getting pre-authorization for a procedure or test. Then there are further delays in getting authorization for the medication.

And any time there is a need to adjust medications due to changes in symptoms, there can be further delays.

Discontinued Treatment

Many medical professionals are experiencing increasing instances of patients not continuing or following through with treatments. The constant delays and administrative work required make the entire process frustrating.

And that leads many patients to abandon treatment or seek non-medical solutions that will likely never help with their health problems.

Impacts Of Prior Authorization On Your Practice Staff

It’s not just patients that directly struggle due to the process. Prior authorizations also have significant impacts on the business activities of healthcare providers.

Increase In Employee Hours

Obtaining prior authorization is a lengthy process. And even with the latest IT solutions to make online submission easier, a huge processing burden is involved.

Many healthcare providers report that the average doctor sees about 30 patients daily. And that can create up to two days of employees’ work to get prior approval. It can often take two or more phone calls to get issues resolved.

Add to that the need for additional follow-up discussions once the patient’s insurance has provided the treatment authorization, and you can see how there is a chain reaction of employee work that increases operational costs.

Dedicated Staffing Requirements

The larger the practice or clinic, the higher the demand will be for staff. With the growing need for requesting prior authorization, staff quickly become overwhelmed.

The first solution is often to hire additional staff, which then also requires a dedicated manager. And this is not the kind of staffing increase that directly improves the patient experience.

Additional Training Needs

The other problem that medical practices have is that insurers regularly change the forms and systems they use for prior authorization. That means you regularly have to train your staff in order to keep up with those changes.

If you don’t keep up with those training needs, then it can quickly result in a situation where you’re submitting forms incorrectly, and you end up in a cycle of follow-ups to resolve those issues.

All of that adds staffing overhead and delays your patient care even more.

Benefits Of Outsourcing Prior Authorization Services

One of the key concerns that medical providers have when it comes to outsourcing to third-party service providers is that they lose control over the process. However, there are critical benefits to consider that come when you hire a team of prior authorization experts.

Fast And Consistent Turnaround

One of the most frustrating things for medical practices is that there is almost always a constant backlog of authorizations to process. That itself starts to cause delays in even getting the process started.

And many businesses also struggle to achieve a consistent turnaround time due to data entry mistakes.

Here at DataMatrix Medical, we specialize in streamlining the process with a large team of prior authorization experts on standby to handle all requests faster than you can in-house.

We have also built processes to ensure we minimize data entry errors, meaning you won’t have to worry about those time-consuming follow-up requests for missing data.

Cost Effective Solution

By partnering with a pre-authorization services provider, you gain access to a large team that can handle more requests than you would encounter on your busiest days. Hiring in-house staff to handle those regular spikes ends up costing a lot of your budget.

But when you streamline the process with DataMatrix Medical, you gain access to a large team at a fraction of the costs and management overhead.

24/7 Prior Authorization Support

The other thing many clinics struggle with is processing prior authorizations outside of normal practice hours. Many medical businesses operate at weekends and even 24/7. Having to wait 12 hours or longer before your staff arrives in the office is not an option. This might be the biggest reason we would recommend outsourcing prior authorization.

At DataMatrix Medical, we offer our clients 24/7 support to handle all authorization requests, especially for small medical organizations, which alone can significantly improve turnaround times.

HIPAA Compliant And Accurate Submissions

Our entire business processes and all system connections with clients are fully HIPAA compliant. That ensures the secure transaction of data between your organization and ours.

In addition, we minimize data errors through both system and manual processes when dealing with your requests. That way, you’ll be confident not to end up in situations where the wrong data is sent, ultimately leading to a poor patient experience.

Find Out How DataMatrix Streamline Your Prior Authorizations

If you’re struggling to stay on top of your prior authorization requests or want to explore ways to speed up and streamline the entire process, call us today to find out how our team can support all your requirements.

This is not going to be a step that makes you lose control over an important business process. DataMatrix will maintain your existing workflow and ensure proper detailed documentation in your EHR.

In addition, you’ll speed up prior authorizations to a level that you couldn’t achieve at an equitable cost.

You’ll vastly improve your patient care and experience and won’t have to worry about future changes to the process anymore.

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