Chiropractic pre-authorizations are a matter of concern not just for the patients but also for the providers. For plans that have pre-authorization in place, the rule is quite simple. If the chiropractor doesn’t obtain it, claims submitted for those services will be denied.
Impact of pre-authorization
Even though a lengthy procedure, the main purpose of pre-authorization is to optimize patient outcomes by ensuring that they are getting the right medication while waste, errors and unnecessary costs are reduced. However, with more insurance plans having their own forms and polices for pre-auth, it is becoming difficult for providers to keep up with the changes. They are experiencing a drastic impact on their practice income if they are failing to obtain proper authorizations.
If the correct authorization isn’t received, insurance companies deny paying for the procedures. Most contracts even restrict the providers from billing the patients which results in serious loss of revenue. Due to the challenges of pre-authorization, not only revenue is lost but it also results in delays in patient care and decline in provider and patient satisfaction.
Another impact of pre-auth can be seen on patients because they experience delay in getting their medication or treatment.
- According to a survey, majority of doctors feel that pre-auth harms patient access to care which eventually damages the clinical quality outcomes. They were also of view that even though the process brings cost containment and accountability, several hours are lost in productivity.
- According to a survey conducted by the AMA, for a submission to get authorized, more than 64% physicians waited for one business day for the pre-auth decision whereas 30% said they had to wait 3 or more business days. During this duration, patients were unable to start the treatment.
Management of Pre-auth
Managing pre-authorization can be a daunting task since requirements vary from one insurance company to another. Each insurer has a different process for submission of pre-auth requests. This means, there is no standardized process and things need to be done manually that can drain resources and time.
To avoid denials, providers need to invest in electronic PA systems that integrate directly with EHR, become more familiar with insurance company’s policies and also employ a system for centralizing the prior authorization responsibility. Providers need to have a clearly defined roles when dealing with PA.