How to manage the rising prior auth burden

Prior authorization challenges have always been such a pain for everybody. However, as the enrollment in Medicare Advantage programs continues to rise, medical practices are further struggling with the increasing problems associated with the authorization process. Leaving providers with –

• Higher administration costs
• Disrupted workflows
• Delayed patient care 

According to the MGMA report, prior authorization requirements for Medicare Advantage have further significantly increased in the past 12 months. With almost 85 percent of respondents of the survey reporting an increase, while less than 1 percent reported a decrease, managing precertification can be really a battle at times.  

How managing prior authorization can be a challenge today? 

Prior auth can be confusing at times – with the constant change in regulations, codes etc; keeping up with the recent industry mandates can be a problem for many and thus, leaving with numerous errors. Furthermore, problem like the transition between Medicare Advantage plans or switching from traditional Medicare to Medicare Advantage resulting in 84 percent of practices having to reauthorize existing services for beneficiaries which can be really confusing for many as it is quite common in nearly 6 in 10 practices. This is why today having complete knowledge and being updated on the authorization rules can not only help with better authorization processes but also ROI. 

Disrupted Workflows and Increased Costs: it is no secret that for years the prior authorization process has historically disrupted many workflows and diverted attention from patient care management resulting in dissatisfaction and also an increase in the error rate. This leaves providers to spend more time rectifying them, where 63 percent of practices end up spending upwards of 35 minutes per request and at times even more leaving with a loss of time and money; practices often end up losing a lot. Besides as prior authorization involves multiple employees, practices have hired or redistributed staff to handle prior authorization requests, additional increasing practice costs. With medical practices already facing inflation, clinical staffing shortages, and rising expenses, the additional burden of prior authorization in fact exacerbates the financial challenges. 

Delays and Denials for Medically Necessary Care: it is no doubt that prior authorization requirements often lead to delays or denials of medically necessary care for many patients.  This is why having a professional will not only faster the authorization process but ensure better authorization approval. 

Sunknowledge – the proficient support solution for your prior auth: 

It is no longer a secret that authorization has been a significant burden on medical practices, leading to increased costs, disrupted workflows, and delayed patient care.
However, with Sunknowledge you no longer have to worry about your authorization trouble anymore.  

Streamlining the prior authorization process and ensuring timely submission, Sunknowledge improves your authorization rate by 1.5-2 x.  By reducing unnecessary administrative burdens, the team further helps in delivering high-quality care to their patients and allocating resources effectively.  

So if you are struggling with your authorization, Sunknowledge can help. For more information on how partnering with Sunknowledge can help get a call with the expert now!