The healthcare industry is looking for some serious transformation with the present administration looking to make substantial changes in the federal regulations. One of the critical areas that every provider is looking ahead is the replacement of the Affordable Care Act.
Also, the present government will require more transparency in the pricing models of the provider’s prices of the services that make prior authorization all the important than ever before.
It is true that every year prior authorization costs are increasing and annually it costs a whopping 31 billion. The present day mandates are surely going to make it increasingly important for the providers to make sure that they have a streamlined eligibility verification process in place.
It will be catastrophic if a practice does not ensure the right checks and balances with their first time PA requests. The amount of time and money spent will increase if a provider lacks the assistance of robust platforms that better practice management methods.
Payers will be more apprehensive in claims adjudication with the proposed expansion of health savings accounts. As a healthcare practice, it becomes pertinent to use specialized skill set and innovative platforms that reduce time as well as expenses in the prior authorization process.
It will be all the more relevant to cater patient care by understanding the required mandates of a particular medical procedure.
Step therapy that intends to control costs and risks posed by drugs in prescription is a direct challenge for the providers that they have to contend with appropriate authorization and verification process.
Reducing billing costs and implementing sound denial management will eventually depend on a synchronized prior approval process. Third party billing partners that render quality assistance and increase transparency will be the need of the hour.
Outsourcing is a pioneer strategy for most providers if they want to attend their healthcare revenue cycle management with a comprehensive strategic objective in place.
Hiring a billing company that provides end to end support in medical billing with guaranteed collections and a determined authorization should lay down a strong foundation to counter the challenges in the present scenario.