Electronic Prior Authorization - Why Your Practice Needs this Technology Now

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As medical practices seek to stay competitive, minimize hassles, and maximize patient care, the demand for up-to-date technology solutions continues to grow. Electronic prior authorization (ePA) is a crucial advancement in healthcare technology that can save time and increase efficiency in the prior authorization process.

But why invest in this technology? Why should you upgrade your EHR to meet your patient’s needs? This blog post reveals why electronic prior authorization is a must-have solution for practices wanting to reduce administrative burden, save time and money, optimize patient outcomes, and remain current amidst rising competition.

What is the Prior Authorization Process?

Prior authorization (PA) is a cost-control process implemented by health plans. It ensures that healthcare providers secure advance approval from the health plan before delivering specific services to patients, making them eligible for payment coverage. Although prior authorization has traditionally been implemented to avoid unnecessary services, there are concerns about how current requirements and manual methods may reduce timely access to patient care. In physician offices, especially larger practices, the time-consuming process of PA can delay treatment and hinder optimal patient health outcomes.

What are some of the more pressing issues surrounding PA? According to an American Medical Association (AMA) survey:

  • 82% of physicians surveyed said prior authorization could lead to patients deserting their course of treatment.
  • On average, 64% of providers must wait a full business day to receive prior authorization feedback from payers. Under a third (29%) found they had to wait at least three business days.
  • 91% of physicians reported that prior authorization could lead to adverse clinical outcomes.
  • 34% said prior authorization has led to a serious negative event for a patient in their care.

The Price of Prior Authorizations

Although health insurers promote PA as a cost-saving measure, the AMA survey revealed that it can increase employee absenteeism and hinder workforce productivity. These issues affect physician offices’ financial viability, especially smaller practices. On average, medical offices must complet 41 prior authorizations per doctor weekly. This workload consumes nearly two full business days of physician and staff time, resulting in 40% of providers employing staff dedicated solely to prior authorizations. In fact, PA processing cost amounted to $528 millionin 2019.

With these challenges, some health insurance companies are trying to find ways to ease the prior authorization burden. For instance, UnitedHealthcare will eliminate nearly 20% of existing prior authorizations for its Medicare Advantage and Medicaid members. Cigna has removed prior authorization process reviews for almost 500 services since 2020, according to Modern Healthcare. However, prior authorization continues to pose financial and operational challenges to physicians - even with these changes. 

As healthcare professionals investigate ways to mitigate this burden, a current tool for streamlining the arduous manual process is taking center stage - electronic prior authorization (ePA). This electronic feature aims to improve the method by sending prior authorization documents digitally instead of via fax or phone. It can be integrated into EHR systems, allowing providers to order a prior authorization within their clinical workflows easily.

How ePA Impacts Quality Care

In general, electronic prior authorization lets healthcare teams accelerate processes like medication delivery by obtaining prior authorization requests in real time. However, to understand how this technology impacts patients and providers, let’s examine the research. America’s Health Insurance Plans founded the Fast Prior Authorization Technology Highway initiative.

The top two findings from the initiative included that the technology can significantly reduce the time between an order for prior authorization and a decision and the time to a patient receiving care. The most notable findings from the study include:

  • 71% of providers who implemented ePA reported faster time to better care.
  • The total number of prior authorizations increased by 34%.
  • The technology reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.
  • 54% of users reported fewer phone calls, while 62% reported less time spent on phone calls.
  • A third of these transactions took two hours or less, compared to before, when 24% of prior authorizations took two days or more to fulfill.

Electronic prior authorization also reduces provider costs, especially in multi-specialty practices. According to a Council for Affordable Quality Healthcare (CAQH) report, the cost to physicians for manually generating a single prior authorization request is close to $11 and nearly $4 using a web portal. In contrast, the cost of creating a request through an electronic portal is less than half. The report suggests the medical industry would save $355 million yearly from a complete shift to the electronic prior authorization process.

Electronic Prior Authorization & EHR Integration

Despite all the advantages of electronic prior authorization, there have been roadblocks. In another paper, the CAQH identifies the top challenges preventing the industry from automating the prior authorization process from end to end. Some challenges include:

  • A shortage of vendor products
  • Demand for data consistency
  • Limited integration between clinical and administration systems

Despite these limitations, 83% of physicians surveyed reported that ePA is still a top priority, and 64% agreed that EHR vendors should provide a service or portal for a streamlined prior authorization process, according to EHR Intelligence.

Simplifying ePA: There is a Better Way

Today, healthcare professionals seek easy, secure, and trustworthy solutions regarding ePA. They also want to integrate this technology within their existing EHR platforms seamlessly. That’s where CoverMyMeds comes in - companies like CoverMyMeds provide ePA solutions that are integrated right into a practice’s EHR, enabling physicians to initiate and submit requests for any medication and all payers directly, all within their current workflow. Transitioning to this technology promises to significantly reduce the time patients wait to begin therapy. With this solution, practices can:

  • Initiate new PA requests at the point of prescribing to reduce the time to dispense
  • Provide an alternative to the manual PA process
  • Electronically submit patient demographic information and clinical questions to the payer

According to CoverMyMeds, “Patients can access their medications 13.2 days sooner on average when providers start the prior authorization request at the point of prescribing compared to pharmacy-initiated requests.”

Understanding the strength of this technology, DrChrono is launching a powerful new integration with CoverMyMeds. Soon, providers and their staff will benefit from ePA solutions that work together in a secure and easy-to-use fully-integrated EHR platform. Now, physicians can save time and money, reduce administrative burdens, fill prescriptions faster, and increase patient satisfaction and quality care all in one powerful system.