Physicians Practice: November 11, 2024, By Keith A Reynolds
How would you characterize your prior authorization experience in the last year?
We’re doing more prior authorizations
74%
We’re doing fewer prior authorizations
4%
Prior authorizations are about the same
22%
Do you think there should be a CPT code requiring payers to reimburse for prior authorization work?
Yes
97%
No
3%
What is your biggest challenge with your biggest payer?
- Current systems don’t interact well with our billing systems requiring office staff to correct claims leading to delayed payment
- Reimbursement stinks. I Quit !!!!!!
- Staff the insurance companies contracted are mostly out of the country and do not know the issues we have and do not like to refer the questions or specific issues to any expert in the field.
- Small practice is ignored. They would not negotiate fees. For more than 15 years no increase in fees, only steady decrease. It is a shame, no respect any longer for providers.
- Prior authorizations waste so much time for what should be a simple process
- Lack of urgency or even motivation to provide basic service
The verdict is in for how practices feel about their payers, and it isn’t good.
How can payers improve their relationship with practices?
- Streamline systems to allow for clean claims the first time
- Have a dedicated Provider Relations contact so we know who to talk to, and who to call to get responses to critical questions, not have to send emails to faceless representatives that have a low rate of resolution.
- Communicate. Show WHY they deny, and what EXACTLY can be done to help the patients who pay them. Do not simply deny with NO guidance.
- Pay us enough to survive. Instead, they raise hospital payments. Paying us more so we could hire more doctors and physicians assistants and keep people OUT of those hospitals.
- Stop putting technology problems and carrier losses on the provider and their patients.
- Instead of looking at me as an expense, look at me as a tool to care for their beneficiaries.
- Stop requiring PAs for generic meds and obviously necessary medications.
