Prior Authorization: The Pain Remains the Same

by Joyce Frieden: For More Info, Go Here…

Despite years of effort, doctors say their PA burdens have gotten worse.

Technology solutions to some of the problems with prior authorization exist, but payers have to be willing to step up and implement them, several speakers said here.

“Everyone agrees we want to do these things, and then what do we actually do about it?” said Tyler Scheid, JD, senior policy analyst for administrative simplification issues at the American Medical Association (AMA) in Chicago. “When push comes to shove, we agree we’re going to do something, but we come up short before we actually get to doing something. As we get a little more vocal and show the world what the problems really are, I think a little media pressure can potentially be an effective approach.”

Prior authorization — the requirement from insurers that providers get pre-approval before they order a particular test, drug, device, or procedure — remains a big problem for clinicians and patients, Scheid said Wednesday at the Healthcare Information and Management Systems Society (HIMSS) annual meeting.

He cited data from the AMA’s 2018 prior authorization survey, which found that 65% of 1,000 physicians surveyed said they had to wait at least 1 business day for a prior authorization (PA) decision, and 26% reported waiting for 3 business days.

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