Prior authorization processing (PA processing) has become one of the most challenging administrative tasks for medical practices. While insurers claim it controls costs and ensures appropriate care, the reality for healthcare providers tells a different story. According to the American College of Physicians and a 2022 survey by the American Medical Association (AMA), prior authorization processing is not only time-consuming but also detrimental to both healthcare providers and patient outcomes.
The Hidden Costs of Prior Authorization Processing
A Major Administrative Burden
The AMA survey revealed that physicians and their staff spend an average of 14 hours per week dealing with prior authorization processing, completing 45 requests per physician weekly. This time-consuming process diverts significant resources away from patient care, forcing practices to either absorb the workload or hire additional staff exclusively for PA processing.
Increased Healthcare Resource Waste
While insurers argue that prior authorization processing helps manage costs, the data suggests otherwise. 86% of physicians surveyed reported that prior authorization processing requirements actually lead to increased use of healthcare resources, causing more waste than savings. These unnecessary hurdles often result in additional office visits, duplicate testing, and ineffective initial treatments, which burden both providers and patients.
Financial Strain on Medical Practices
In addition to the time spent, prior authorization processing can place a significant financial strain on practices. The need to dedicate staff solely to PA processing increases operational costs, while delayed or denied authorizations can disrupt the revenue cycle. Practices often face denied claims, rescheduled procedures, and delayed reimbursements, all of which negatively impact cash flow.
The Impact of Prior Authorization Processing on Patient Care
Delays in Treatment
Perhaps the most alarming consequence of prior authorization processing is its impact on patient care. According to the AMA survey, 94% of physicians reported that prior authorization processing caused delays in care, preventing patients from receiving timely treatments and medications. These delays can exacerbate health conditions, leading to worsened outcomes and unnecessary suffering.
Treatment Abandonment
Prior authorization processing not only delays care but also discourages patients from following through with their treatment plans. 80% of physicians noted that these delays often result in patients abandoning their recommended course of treatment. The frustration of navigating insurance approvals can deter patients from pursuing essential care, leading to avoidable health complications.
Serious Adverse Events
The consequences of delayed care extend beyond inconvenience. 33% of physicians surveyed reported that prior authorization processing requirements had led to serious adverse events for patients, including 25% who witnessed hospitalizations as a direct result.
Why Efficient Prior Authorization Processing is Essential
Given the administrative burden and the potential for harm to patients, efficient prior authorization processing is critical for medical practices. Streamlining this process not only reduces operational costs but also ensures timely, effective care for patients.
Improved Patient Care
By reducing delays and ensuring faster approvals, practices can prevent treatment interruptions and improve patient outcomes. Efficient PA processing means quicker access to medications and procedures, allowing patients to stay on track with their treatment plans.
Reduced Administrative Strain
An optimized PA processing system frees up physicians and staff to focus on direct patient care rather than paperwork. This can help reduce burnout, improve staff morale, and create a more efficient practice overall.
Better Financial Health
Efficient prior authorization processing leads to fewer claim denials and faster reimbursements, contributing to a healthier revenue cycle. Practices can avoid the costs associated with delayed approvals and ensure consistent cash flow.
How 1st Call Practice Solutions Can Help
At 1st Call Practice Solutions, we understand the complexities and challenges of prior authorization processing. Formerly known as 1st Call Triage, we’ve rebranded to better reflect the full spectrum of services we provide, but our commitment to delivering exceptional support remains unchanged. It’s a new name but the same great suite of services designed to streamline your practice operations and reduce administrative burdens.
Our team of experts specializes in medical call center and staffing solutions that help optimize administrative workflows, including PA processing.
Benefits of Partnering with 1st Call Practice Solutions:
- Expert Handling – Our trained staff understands the ins and outs of PA processing requirements across various insurance providers.
- Faster Approvals – We manage the process from submission to follow-up, ensuring quicker turnaround times.
- Reduced Costs – Free up internal resources and avoid the costs associated with hiring additional staff for PA processing management.
- Improved Patient Outcomes – With fewer delays, your patients receive timely care, leading to better health outcomes and higher satisfaction.
Book Your Free 15-Minute Discovery Call
Ready to simplify your prior authorization processing? Book a 15-minute Discovery Call with our owner, Cayce Branyon, to learn how 1st Call Practice Solutions can help your practice save time, reduce costs, and improve patient care.
