The state of Cardiology Prior Authorization

As medical sciences continue to introduce newer drugs and procedures, prior authorization continues to grow increasingly complex as well. In the realm of cardiology, prior authorization today is associated with a plethora of medication, surgeries and treatment procedures, along with hundreds of screening processes and diagnostic investigations. This is a situation that is also made more acute with the regular arrival of new players in the healthcare insurance market. To cut a long story short, cardiology prior authorization requirements offer a mind-blowing diversity and a kind of complexity that often becomes unmanageable for many small to medium sized practices.

Two of the main complaints about prior authorization are the amount of time providers are usually required to spend for it, and the amount of strain it puts on a healthcare facility’s billing resources, often necessitating engaging nurses and other healthcare personnel to handle the burden, and thus keeping them away from actual patient care. As one takes a critical look at the process, it becomes plainly evident that prior authorization is a process that is still being followed using antiquated methods, such as involving a good deal of paperwork, sending faxes and making lengthy telephone calls. Recent surveys have revealed that on an average, for a typical practice, a week’s volume of prior authorization work can be almost equal to 2 business days’ time.

A step towards improved efficiency

In a bid to free up a facility’s resources from being occupied with a tedious process like prior authorization, a large number of healthcare practices across the U.S. are enlisting external help. Given the complex nature of the process, unless one is closely familiar with payer norms and the various caveats of reimbursement, the efforts to get a prescribed drug or procedure prior authorized can result in failure. With expert, professional assistance, such denial rates can be sharply reduced.

Professional and dedicated intervention also means the employment of streamlined methods that directly contribute to a rise in overall efficiency. With skilled personnel working dedicatedly on getting a prescription prior authorized, providers notice a noticeable rise in their collections, with more requests getting completed successfully in less time.

Ranging from specialty drugs to nuclear medicine, from a catheterization to an echocardiogram or an MRI scan, cardiology prior authorization requirements can be extremely varied. By engaging a dedicated and specialized panel of experts, providers can effectively stop worrying about having to handle such diverse complexities by themselves, and can find more time to focus on their practice and patient care.