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October 21, 2019

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Can We See Relief from Prior Authorizations?

January 19, 2018

 

It is fair to say that the process of obtaining authorization prior to a procedure or costly medication has become quite burdensome for many of our practices. Personally, it has been frustrating to see staff jump over and through countless obstacles and hoops just to help one patient get the medication they need. It’s even more frustrating when payment is denied based upon a technicality or a mistake on the payer’s part. Well, hopefully a recent collaboration will begin to improve the way we do prior authorizations.

 

A number of healthcare stakeholders have put out a Consensus Statement to demonstrate their plans to streamline the prior authorization process. This group includes associations from hospitals, medical groups, pharmacy and health plans.

A few examples of what they have committed to work on include:

  • Encourage review of medical services and prescription drugs requiring prior authorization on at least an annual basis, with the input of contracted health care providers and/or provider organizations

  • Encourage transparency and easy accessibility of prior authorization requirements, criteria, rationale, and program changes to contracted health care providers and patients/enrollees

  • Improve communication between health care providers, health plans, and patients to facilitate continuity of care and minimize disruptions in needed treatment

While the intention of bring down the cost of care may have been admirable, the ever-growing administrative burden that has been placed on the provider has got to change. MedMan supports the movement by these organizations in streamlining the prior authorization process and specifically providing relief to private practices.

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