Prior authorization has always been a pain point for healthcare providers, patients, and other stakeholders involved in the healthcare ecosystem. As it is quite a complicated process that results in various challenges that not only create administrative burdens but also hinder patient care.
So we are here to discuss the key issues associated with prior authorization, the recent updates in the Medicare Advantage (MA) and Part D Final Rule for 2024 and how collaborating with an expert partner like-Sunknowledge as the expert can help you sail through the complexities of prior authorization.
Tackling the Prior Authorization Hurdles:
- Time-consuming process: Prior authorization demands significant time and effort, with physicians spending two to three business days per week on these procedures, which is often taking away precious time meant for patient care and at times causes treatment delays.
- Administrative burden: Handling prior authorizations necessitates significant resource allocation, including hiring or redistributing staff, which not only puts extra costs and administrative strain on retaining them.
- Delays in patient care: According to the American Medical Association (AMA), 93 % of physicians believe that patients face delays in receiving necessary care as they wait for health plans to authorize treatments or services. These delays can lead to adverse health outcomes and increased expenses.
- Inconsistent policies: Prior authorization requirements can vary varies drastically across different MA and Part D plans, causing confusion for healthcare providers and attempting to navigate these inconsistencies only contributes to additional administrative burdens and potential errors.
- Abandoned treatment: Prior authorization challenges and delays can sometimes cause patients to give up treatment entirely, jeopardizing their health and well-being.
- Variability in coverage criteria: Coverage criteria for medical services and prescription drugs can differ between traditional Medicare and Medicare Advantage plan, creating disorder for healthcare providers and beneficiaries and potentially affecting the quality of care.
- Inefficient communication: The prior authorization process often involves numerous interactions between providers, payers, and pharmacies, with inadequate communication it is more prone to errors, resulting in delays or denials.
- Appeal process challenges: When prior authorization requests are denied, providers and patients often encounter lengthy and complex appeals processes, further delaying care, more chances of abandoning the treatment and increasing administrative burdens.
- Lack of transparency: Providers and patients may find it challenging to obtain clear information on prior authorization requirements and coverage criteria, making it difficult to navigate the process effectively.
With all such confusion and to address all these concerns, the Centers for Medicare & Medicaid Services (CMS) recently introduced the 2024 Medicare Advantage (MA) and Part D Final Rule with key suggestions enclosed:
- Clarifying clinical criteria guidelines
- Streamlining prior authorization processes
- Providing a 90 – day transition period when beneficiaries switch Medicare Advantage plans
- Requiring annual reviews of utilization management policies.
In fact, today to streamline your prior authorization services, its best to have expert support managing your authorization complications.
Sunknowledge: an expert for Prior Authorization in Medicare Advantage and Part D:
With decades of experience in the healthcare sector, Sunknowledge has assisted numerous providers in swiftly and efficiently closing all your pre auth gaps faster and efficiently.
By keeping up with the latest regulatory changes, Sunknowledge’s team further reduces your chances of error rate, ensures 100 % authorization submission on the same day, and strives to alleviate the burden of prior authorization while enhancing patient care.
So, if you are grappling with your prior authorization burden or require help managing authorization submissions, Sunknowledge Services Inc., is your one-stop destination for all your prior authorization complications and needs.