Prior authorization reality of 2023

Struggling with prior authorization?? You are not alone in this.?

It is no doubt that the prior authorization or the PA has been a controversial issue in the healthcare industry for years now. Causing concerns for both physicians and patients, prior authorization is quite a stressful job. Even though in 2023, significant developments and opinions surrounding pre certification have come to light, dealing with authorization has always been a time consuming affair. Though there are continuous efforts yet, we see practices still struggling to obtain a seamless pre authorization.?

All about prior auth statistics - 2023:?

Delays and Administrative Burden - According to a survey conducted by the American Medical Association, a staggering 94% of physicians reported that prior authorization processes led to delays in patient care and increased administrative burden. This is a striking issue that affects the efficiency of healthcare delivery.?

Time Devoted to PA - In 2022, the same survey found that 39% of physicians spent one to nine hours per week on prior authorization. This significant amount of time detracts from direct patient care, causing frustration among healthcare providers.??

PA Actions by Health Systems and Insurers:??

?Health Systems Canceling Contracts - In 2023, eight major U.S. health systems have taken the bold step of canceling their Medicare Advantage (MA) contracts. They often cite low reimbursement rates and the hassles associated with prior authorization as primary reasons for this decision. This move underscores the impact of PA on healthcare providers.?

Humanah Eases PA for Cataract Surgery - Humanah has made a notable change by rolling back a prior authorization requirement for cataract surgery for Medicare Advantage beneficiaries in Georgia. This is a significant step toward streamlining the process.?

Cigna and Blue Cross Blue Shield's Efforts - Cigna Healthcare has removed nearly 25% of medical services from prior authorization requirements, eliminating more than 600 procedures. Additionally, Blue Cross Blue Shield of Michigan announced a new initiative aimed at reducing prior authorization requirements by 20%. These actions are in line with the broader goal of improving healthcare quality and access while reducing administrative tasks.?

UnitedHealthcare's Phased Approach - UnitedHealthcare has embarked on a two-phased approach to eliminate prior authorization requirements for several procedure codes, with the aim of reducing PA by 20%. This indicates a growing recognition of the need for change within the industry.?

PA Legislation Actions by States:?

California's Bold Move - The California legislature is considering a bill that would prohibit prior authorization for any healthcare service if the plan or insurer approved, or would have approved, not less than 90% of the pre authorization requests a provider submitted in the most recent completed one-year contracted period. This could signal a significant shift in how PA is regulated.?

Michigan's Reforms - Michigan has taken action to streamline PA processes by launching new rules in June, with the goal of making the system faster, more effective, and transparent. These reforms aim to benefit both healthcare providers and patients.?

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As you know the landscape of prior authorization is quite complex and constant updating. It can be not only be confusing and also leave many with errors, delays and low reimbursements. So to ease the burdens associated with prior auth and experience efficient and transparent authorization, its best to have an operational extension taking care of your authorization complications constantly by your side. In fact, there is RCM organization – Sunknowledge Services Inc known for closing the authorization gaps not only faster but also efficiently. Providing numerous ways to strike a balance between administrative efficiency and quality patient care, while getting your prior authorization done effortlessly, Sunknowledge ensures 100% submission the same day. Increasing the authorization rate by 1.5-2x and shrinking the operational cost by 80%, the expert further ensures an accuracy of 99.9%?

In short, with so much guidelines, stress and confusion having an operational partner like Sunknowledge play a crucial role in streamlined your authorization operation and shaping the future of healthcare delivery.?