Prior authorization represented the biggest cost-saving opportunity for providers

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• Prior authorization represented the biggest
  cost-saving opportunity for providers

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Prior authorization represented the biggest
cost-saving opportunity for providers
Prior authorization is a check conduct by some
insurance companies or third-party payers in the
United States before they agree to cover specific
prescribed medications or medical procedures for
patient. Prior authorization costs accounted for
approximate two percent of overall medical
industry spending on administrative transactions
in last year 2019. Analyzing data from medical
plans covering nearly half of the insured US
public, Council for Affordable Quality Healthcare
found that the implementation of electronic prior
authorizations improved by just one percentage
point from 2018 to 2019 to 13 percent. Prior
authorizations represented the biggest
cost-saving opportunity for providers.
Researchers estimated that providers could save
355 million by shifting to fully electronic
prior authorizations. An electronic way for prior
authorizations has been in place since the early
2000s. Medical industry facing barriers and hence
cannot fully automate the transactions. Barriers
include provider awareness, vendor support,
inconsistent use of data content allowed in the
standard, state laws mandating manual processes,
and lack of an medical documentation. According
to MGMA, last year that prior authorizations
topped the list of regulatory burdens for medical
groups. The associations survey of medical group
leaders showed that prior authorizations were
very or extremely burdensome for most
organizations.
Medical Billing Services in Oregon
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Prior authorization represented the biggest
cost-saving opportunity for providers
Manual Rapid increment in the face of manual PA
and pressure from the value-based care model, the
need is addition of real-time electronic PA
systems that will simplify the administrative
burden on stakeholders throughout the healthcare
ecosystem. PA costs quickly compound into a
significant burden. The high cost problem of PAs
presents an equally large opportunity. The change
to electronic PA systems has yet to result in
significant cost savings and/or personnel
reduction. Currently, the huge majority of
payers are committed to executing electronic PA
solutions. Physicians report that they wait at
least one business day for a PA decision.
Patients often become discouraged by the PA
process. Physicians say that PA programs have a
negative impact on patient clinical
outcomes. These challenges can interfere with
provider care plans, especially as physicians
might not immediately know that a delay has
occurred. As Prior authorization will continue to
be an important cost-containment tool for payers
and plan sponsors. The importance of a system
that works for todays providers and patients
only grows.
Medical Billing Services in Oregon
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Prior authorization represented the biggest
cost-saving opportunity for providers
About Medisys We are a group of medical billing
experts who offer comprehensive billing and
coding services to doctors, physicians
hospitals. We provide end to end billing and
coding solutions. Medisys Data Solutions RCM
solutions ensures that the providers recover
every they are entitled to. Our vision for the
providers is You Cure. We ecure. Schedule a
call with our billing expert to outsource your
Prior authorization process.
Medical Billing Services in Oregon