According to the American Medical Association (AMA), the national volume of prior authorizations (PAs) has significantly increased in the past five years, with an average of 33 PA requests received per physician each week across various practices. Additionally, medical authorizations can be one of the most frustrating barriers to effective patient care contributing to care delays in 92% of cases. As the U.S. healthcare system has been overwhelmed, short-staffed and has lacked proper personal protective equipment (PPE) and medical equipment to cope with COVID-19, the need for streamlining administrative tasks has never been as imperative as it is now. The pandemic has exposed cracks in the healthcare system, showing opportunities for growth. Many decisions are being made that will impact the future of the industry. One topic that is frequently discussed is weighing the benefits of prior authorizations for all key stakeholders.
At their core, prior authorizations are designed to ensure that patients receive the right care at the appropriate time in an efficient manner. Continuing advancements in medicine and evolving regulations mean payers, providers and patients alike must navigate increasingly complex medical policy guidelines and standards. In light of this, many payers are grappling with whether or not to suspend prior authorizations. On one hand, the suspension could potentially help to get reimbursement payments to providers as quickly as possible, thereby easing financial concerns. After all, prior authorizations are a provider’s most costly transaction. The 2019 CAQH Index report found that manual prior authorizations averaged a cost of $11 each – almost double the average cost of a transaction in 2018. A suspension could then provide administrative relief for the healthcare provider community and reduce reimbursement delays.
On the other hand, as payers and providers grapple with how this decision unfolds, one of the main concerns is the risk of a decline in value-based care. That is because, at their core, prior authorizations reinforce evidence-based care. In a recent AHIP survey, nearly all of the participating plans (98%) developed their prior authorization programs using peer-reviewed studies. Furthermore, the suspension of prior authorizations runs the risk that patients will be faced with surprise bills that would otherwise have been avoidable with proper verification and pre-approval.
Thankfully, technology can help to streamline workflows and aid the prior authorization process. For example, open authorizations allow providers to submit medical prior authorization requests and access the most up-to-date authorization information from health plans, such as status updates, approvals or denials and requests for additional information.Learn more about how NaviNet AllPayer Access utilizes a multi-payer experience to expand access to over 1,000 health plans.
