Prior authorization can be a long process for physicians and patients, resulting in time delays, increased paperwork and disrupted patient care.
According to a March 14 report from the AMA, physicians and their staff spend up to two whole workdays per week filling out prior authorization paperwork, with some practices forced to hire additional staff just to handle prior authorization claims.
Additionally, according to data from the Kaiser Family Foundation, Medicare Advantage insurers deny, or partially deny, over 2 million claims a year.
Domagoj Coric, MD, spine and neurosurgeon at SpineFirst at Carolina Neurosurgery and Spine Associates in Charlotte, N.C., and an endowed professor of spine surgery at Atrium Health in Charlotte, believes that reform is long overdue.
Dr. Domagoj Coric: A long overdue payer change is prior authorization reform. The prior authorization process is an onerous and opaque process, mandated by payers, which consumes significant healthcare resources.
This wasteful process is exacerbated by the fact that prior authorization approval does not guarantee payment. The entire pre-approved surgical procedure is routinely denied payment if any additional procedure is performed. This is an unconscionable situation. At a minimum, obtaining prior authorization should equate to insurance coverage and payment of the pre-approved codes.
Any additional procedures can subsequently be adjudicated based on medical necessity. Hopefully, 2023 will bring substantial prior authorization changes.