Prior Authorizations: 3 Ways to Reduce Administrative Burden & Burnout

A study by the Kaiser Family Foundation found that four in five Medicare Advantage enrollees are in plans that require them to obtain authorization from insurers prior to receiving care. Conversely, traditional Medicare does not require prior authorization for the vast majority of services. The adoption of electronic prior authorization transactions could take years, so let’s look for ways to foster better communications and transparency between providers and health plans to minimize care delays. Inside hospitals, for example, nurse case managers are the quarterbacks of care, wrangling insurance companies, providers, families, and physicians to find medical services for patients who need care following treatment for injury or illness. 1. Integrate workflows: Case managers are spending 60% of their time obtaining authorizations so they can discharge patients to the next level of care. And at least 2,000 times a month, five-plus calls had to be made to insurers regarding the status of a prior authorization request. They are spending more time managing prior authorizations, as more people enroll in Medicare Advantage plans.