Lack of Prior Authorization Ruining Medicine for Physicians

Did you know, majority of physicians have a negative view of prior authorizations?

It not only adds to their administrative burden but also causes significant delays in care delivery.

  • In a survey conducted by the AMA (American Medical Association), 91% surveyed physicians were found to be frustrated due to prior authorization requirements. They said that it extended the waiting period for treatment and negatively impacted their care process.
  • Majority of prescriptions that get rejected at the pharmacy require prior authorization. Due to the imposing of these requirements, very few patients end up getting the originally prescribed medicine and majority end up abandoning the therapy altogether.
  • On an average, 31 prior authorizations per physician per week need to be completed by practices. This equals to almost two business days or almost 15 hours every week for administrative tasks.
  • As per a study, it was estimated that PA requests, on an average, consumed around 20 hours a week per medical practice. This includes 1 hours of the doctor’s time, approximately 6 hours of clerical time and 13 hours of nurses’ time.
  • Each PA submission can take approximately 30-40 minutes which is quite a lot considering the amount of workload a practice has to deal with.

Impact on Income

There are multiple steps that have to be followed for proper prior authorization. From securing the correct form and filing it out with the right details to submitting the form to the plan, every steps needs to be completed in an accurate manner. If prior authorization isn’t obtained, it can have a drastic impact on the income of the practice. No authorization which mean no payment. This is because insurance companies don’t pay for procedures if correct PA hasn’t been received. Also, most contracts restrict a practice from billing the patients.

With every passing years PA is getting expensive to handle. Therefore, to survive in business and keep making money, it is important for medical practices to have robust processes in place. They will need a specialized partner for improving the PA process flow. Only a good team will ensure that PA service is timely and done in the right manner.

Since the PA process is burdensome and disruptive to care, many practices choose to outsource it to a third party. This helps them streamline the prior authorization process to deliver quality care and obtain timely payments.


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