Prior Authorization a Broad-Reaching, Significant Problem for Practices


Ask any physician, in nearly any specialty, about prior authorization and the message will be clear: obtaining necessary pre-approvals for physician services is a time-consuming problem. And, as a growing number of private insurers are requiring prior authorizations, it’s only going to get worse.

In response to an online survey by Urology Times in 2014, 84 percent of respondent reported a significant increase in the number of prior authorizations processed by their offices over the previous two years. Of remaining 16 percent, 14 percent indicated that it had “increased somewhat” which 2 percent indicated no change. None of the respondents reported a decrease. The impact of prior authorization requirements is significant. In a 2016 study published in Health Affairs Casalino et al reported that that average physician’s practice devoted one hour of physician time, 13.1 hours of nursing time and 6.3 hours of clerical time to obtain prior authorizations for various services.  

While there are many services, such as drugs and surgeries, affected by this requirement, it is not always easy for practices to know the services for which prior authorization will be required. According to a survey conducted by the American Medical Association in 2010, nearly two-thirds (64 percent) of physicians reported it was difficult to determine which tests and procedures required prior authorization, while more than two-thirds (67 percent) reported difficulty in determining what drugs required prior authorization. This is further complicated as rules tend to vary from state to state.

The AUA Reimbursement and Regulation Department has been closely monitoring this topic of prior authorization, and has been working with multiple committees and workgroups within the AUA to determine next steps. Recognizing that the burden of prior authorization transcends specialties, the AUA has been working closely with the American Medical Association to gather and share information while simultaneously working on tools specifically designed to assist urologists. At its 2014 House of Delegates Interim Meeting, the AMA adopted a new policy calling to limit the use of prior authorization of healthcare services. The policy directs the AMA to conduct a study that quantifies the administrative burden of prior authorization and authorization denials that physicians are encountering. This study took place in 2015, and results should be made available sometime in 2016.

What do practice managers have to say about prior authorizations? Find out in part two of this series, which will be published on May 17.

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