Guess which single task accounts for nearly two days of your staff’s work, each week, to support the average physician: Prior authorizations. Physicians and practice staff spend 14.6 hours securing 29.1 prior authorizations, per physician each week.1 Over the course of a year, that can add up to as much as $85,000 spent to support a full-time physician,2 and it can often be time wasted—a nurse could spend 45 minutes on hold with a payer only to learn that a prior authorization is not needed for the service being ordered.
Health plans vary widely in their requirements, and keeping up with requirements is complicated and costly. In fact, missing authorizations account for 16 percent of denials when claims are first submitted—and ultimately, 25 percent of denial write-offs.3
In addition to financial ramifications, the authorization process can also impact patient care. In a survey of physicians, 92 percent reported care delays due to the challenges of securing prior authorizations. And the impact of delayed care can be dangerous: 78 percent of those surveyed reported that delayed authorizations can lead patients to abandon treatment.4
Hours spent on the phone with payers are hours taken away from patients. Given the significant toll that prior authorizations can take on a practice, outsourcing this work may be a better alternative to handling it within your practice.
1. American Medical Association. 2018. “2017 AMA Prior Authorization Physician Survey.” Accessed April 23, 2018. https://www.ama-assn.org/sites/default/files/media-browser/public/arc/prior-auth-2017.pdf.
2. Morley, C.P., Badolato, D.J., Hickner, J., Epling, J.W. 2013. “The Impact of Prior Authorization Requirements on Primary Care Physicians’ Offices: Report of Two Parallel Network Studies.” Journal of American Board of Family Medicine, 26 (1): 93-105. doi: 10.3122/jabfm.2013.01.120062.
3. Advisory Board Financial Leadership Council. 2014. “Benchmarking Revenue Cycle Performance: Results from the 2013 National Survey of Hospital Revenue Cycle Operations.” Accessed April 23, 2018. https://www.advisory.com/research/financial-leadership-council/studies/2013/benchmarking-revenue-cycle-performance.
4. AMA 2018.