Here is how you can reduce the burden of the time-consuming and cumbersome process of prior authorizations.

Prior authorization is one of the principal ways that healthcare professionals seek to control costs. It is mandated by policymakers to ensure coverage of certain drugs and step therapy. However, it is also one of the leading concerns of primary care providers, who refer to it as an extreme exasperation in clinical practice. At the same time, it is blamed for adding another layer of burden to the medical practice. Director of Health Health Information Technology Policy and the Medical Group Management Association (MGMA), Robert M. Tennant, MA, identifies prior authorizations  services as the most challenging problem that a practice has to undergo. However, while it can cause delays in delivering care, it is perhaps the only administrative activity that impacts patient care.

Here are the top 10 strategic moves that you can deploy to ease off the associated burden:

Hire Dedicated staff

Navigating the prior authorization process is particularly steep and time-consuming. Having dedicated staff that only looks after this activity can prove helpful in easing off the associated burden. This staff will essentially act as a liaison between various payers, thereby navigating the process at a faster pace and with relative ease.

Automate the Process

Make good use of technology and automate the process. Integrating Electronic Health Records (EHRs) with the practice’s system will especially help overcome numerous manual processes, the doing and redoing of jobs, and hence save time.

Document Evidence

It would help if you documented everything, from the medication choices to why you made those choices. This evidence-based practice will help you make better decisions, especially when you will be well-aware of the generic options available. It will also become handy in the event a payer defaults.

Create a Directory

One way to manage prior authorizations is perhaps to eliminate the need for them. It is advised that you create a spreadsheet or a directory of what all is allowed under a payer’s plan. This is intended to act as a reference guide for the next payers.

Prepopulate Forms

For every payer, there is a process, and for every process, there is a form. Prepopulating forms can potentially save a lot of time, streamlining the entire process. The same time can be diverted to other payers and make the overall practice much more time-efficient as well as cost-effective.

Streamline Processes

Document every step of the process of prior authorization with every company. Establish proper workflows for every step of the process, from approvals to denials and appeals, and have everything written. This will act as a guide to follow with the next payers.

Enlist Clinicians with ‘Gold Cards’

Payers often offer recognition to clinicians with a proven track record of using medications that are on the payer’s formulary, or who are an affordable care option. They offer them ‘Gold Card’, as a reward for ordering tests and medications and as a reward for providing above-par services. You must make a list of insurers that offer this service and take benefit.

Devise Patient-Centric Plans

More than often, patients are met with surprise at their pharmacy visit, despite their best efforts to stick to a plan’s formulary. You must educate your patients about all available options, including self-pay discounts, to help create a plan when they face any issues.

Aim at relationship-building

Establishing healthy relationships with your payers can also prove helpful in easing out the burden of prior authorizations. As with any other vendor or supplier, it can be easier to find solutions when you know you have a specific person to turn to. You must identify and assign a source to every payer, in addition to the dedicated staff to managing prior authorizations, to navigate the process to and address any particular payer-related problems.

Advocate for Change

Prior authorization is not a routine task that will enhance clinical efficiency in the short-run. You must continually advocate for change and ask policymakers to develop consistent methods and techniques for authorizing medications. The ultimate objective is to have set core quality measures and standards that help make the entire process smooth.