Prior authorization, or PA, is a requirement for certain medications and treatments. Before you can receive the care you need, your insurance company may need to grant approval first. Sometimes the process is handled before you get to the pharmacy, while other times you may be told you have to wait for your insurance provider to allow you to get the prescription through them. Let’s take a closer look at everything you need to know about prior authorization for medications.

What is Prior Authorization for Medication?

So, what is a prior authorization? Before a physician is able to administer certain medical procedures, devices, or specific medications, they may need to follow the process to get approval from your insurance company. Prior authorization has to be requested before the request for your insurance to cover all or a portion of your treatment. Your physician’s request may even be denied.

Why a Prior Authorization is Required by Insurance

According to health insurance companies, prior authorization is required for some treatments, medications, procedures, and medical devices to keep the cost of healthcare lower.

Medications That Need PA

Prior authorization is a requirement for several different medications. The request may be necessary for a number of reasons, including:

• The medication is expensive (such as rheumatoid arthritis and psoriasis medications)
• There is a cheaper generic version available and the physician is requesting the brand name
• Used to treat conditions that are non-life threatening
• Used at doses higher than normally recommended
• Cosmetic use (such as wrinkle treatments and hair growth)
• Your physician deemed it medically necessary (if this is the case, they need to inform the insurance company that other medications that are covered will not be effective forms of treatment for you)

How to Tell if You Need Prior Authorization

Finding out if your insurance company requires prior authorization is easy. Calling your insurance company and asking them directly is a good way to go. Otherwise, your pharmacy will inform you if prior authorization has been requested by your doctor when you go to fill or pick up the prescription. If it has not been approved, they will charge you the full amount.

How Prior Authorization Works

When your doctor requests a prescription for you, they should contact your insurance for prior authorization. If they did not, however, your pharmacy will contact the doctor to let them know the authorization is required. Once they are aware that approval needs to be requested, your doctor or a member of their staff will reach out to your insurance to get the forms filled out and submitted. This can take a while, depending on your insurance company.

In addition to the paperwork your doctors’ office submits on your behalf, your insurance provider may also require you to fill out some forms as well. You should call them to see if there is anything you need to do on your end before they review and approve your request. Once the insurance company has made its decision, it will contact you, your doctor, or your pharmacy about whether the request was approved or denied.

How Long Does it Take?

In most situations, prior authorization takes a few days to process. The specific time frame depends on what type of medication or procedure your physician has requested, along with the insurance company you have. If you haven’t heard anything by a week after your initial discussion with your doctor, you can contact the pharmacy to see if the request was approved. If your submission was not approved, the next step is to contact your insurance company directly to find out why the request was denied or delayed.

A doctor’s office is best when everyone knows what they’re doing. If the environment of the office is chaotic, it will clearly show in all aspects. This is where having a medical practice management system becomes useful. 

Without a way to handle the countless tasks that make up an average day at the office, you can expect chaos on a day-to-day basis. 

Take note of how long it takes for a current patient to get checked in. If it’s taking longer than 10 minutes to check in an old patient, your health practice could be in desperate need of medical practice management. 

Anywhere your practice could be doing something more quickly, is where you need to be proactive. Life is easier when you decide to add a medical practice management group to your office. 

What is the Basic Definition of Medical Practice Management?

Medical practice management is defined as healthcare software used for completing financial and administrative tasks daily. 

Running a doctor’s office efficiently means having the right resources in place, such as a medical practice management system. Patients can tell when an office is clearly disorganized and that’s the last thing you want as a doctor. 

Hiring a professional medical billing company can help with improving the overall flow of how your office runs on a day-to-day basis. Medical practice management systems are a huge reason for more healthcare providers deciding to ditch a paper filing system. 

What Can A Medical Practice Management System Do?

The facts are this, having a medical practice management system makes running your healthcare practice a breeze. Instead of having to lug around multiple, bulky files, it’s simple to find everything you need for an appointment at your fingertips. 

Patients can easily:

• schedule appointments.
• send a message to their healthcare provider.
• request prescription refills.
• Make payments. 

Healthcare providers can:

• view/share lab results.
• respond to any patient messages.
• view all patient health records. 

Front desk employees will find it simple to:

• access/edit basic patient information.
• schedule any appointments made via phone calls quickly.
• update patient insurance info

Skip having to manually input everything with pen and paper. This kind of medical software makes completing daily tasks easy for everyone.

What Are The Benefits of Medical Practice Management?

There’s an unlimited amount of benefits for using medical practice management. If you’re thinking that there has to be an easier way to do admin tasks, you’re right. There’s no reason to suffer from constantly losing and replacing important paper files.

The benefits you will reap from adding a medical practice management program are:

• Enhanced Communication 

• Instead of having to make a phone call for a simple question, patients can send a quick message to the front desk secretary, or their preferred healthcare provider. No more unnecessary games of phone tag when the patient is trying to get their lab results. 

• Ease of Access to Patient Records

• In older offices, you’ll notice everything is done on paper. However, with medical practice systems, all work and tasks can be completed on a tablet, laptop, and desktop computers. 

• Automated Services

• Front desk employees will appreciate that patients can schedule their own appointments using an online calendar, plus it only takes a couple of clicks to request a refill. 

The old days of paper filing are over, and the new days of electronic takeover in health practices have begun. You know how the saying goes: you either get with the times or get left behind. 

Patients will ultimately begin flocking to the healthcare offices that have the latest in healthcare technology. A healthcare office that’s lacking in updated technology will not only have trouble keeping patients but also have a good amount of trouble keeping up the daily workload. 

How To Incorporate Medical Practice Management Systems

The most crucial part of every doctor’s office is the software they are using to successfully run their business. When everyone can do their job the most efficiently, clients will be happy. Happy clients mean they will be back for more health-related services. 

So you want to implement a medical practice management system, but don’t know where to start? Well, it’s a simple process, contact a professional medical billing company.

Call today to get a free audit of your healthcare practice’s financial account.