Prior Authorization Challenges Facing Neurology

The need for prior authorization affects nearly all specialties within healthcare, including neurology practices. 

Health insurance companies use the prior authorization process to determine whether or not a specific drug, procedure, or treatment is medically necessary before it can be prescribed or performed.

This process of getting approval from an insurance company can be time-consuming, creates additional stress for neurologists and patients, and can interfere with providers’ ability to deliver quality care.

This article explains some of the most significant pre-certification challenges facing neurology departments, as well as how Adonis’s prior authorization solution can help providers manage them.

Prior Authorization Difficulties Impacting Neurology Practices

Many healthcare providers, including neurologists, have witnessed adverse effects brought on by the demand for prior authorization before they can prescribe a drug or perform a procedure.

For example, according to a survey from the American Medical Association, 25 percent of physicians have seen prior authorization lead to a patient’s hospitalization.

Nineteen percent also saw it result in a life-threatening event, and nine percent reported it contributing to a patient developing a disability or experiencing permanent bodily damage, a congenital anomaly, or even death.

Prior authorization creates so many problems because it requires physicians to delay care. For example, they often have to wait at least a day before they can prescribe medication or administer treatment. When they’re dealing with a patient experiencing severe neurological symptoms, that delayed care can worsen their symptoms and put the patient’s life at risk.

In addition to delaying care, prior authorization requirements can also limit the amount of time neurologists and other providers can spend with patients answering questions, addressing concerns, etc. This limited time, in turn, leads to a diminished patient experience and may interfere with their ability to understand their condition fully.

Not only does a demand for prior authorization interfere with the patient experience (and potentially put the patient's life at risk), it also creates administrative and financial difficulties for neurology practices.

When a provider has to deal with delayed payments or work with a patient to create a payment plan because the insurer denied coverage, they face revenue management difficulties. They also have to spend additional time working on these financial matters instead of meeting with and caring for patients. 

How Adonis Improves the Prior Authorization Process

The demand for prior authorization from insurance carriers is unlikely to go away anytime soon. However, solutions like Adonis’ can make the process easier and prevent it from interfering with patient care.

Adonis’ solution is designed to streamline prior authorization workflows and provide valuable insights to help neurologists and other providers gain a better understanding of how their patient access and pre-certification processes are performing.

With Adonis, neurologists can review a patient’s insurance policy and medical information to see if prior authorization is needed. Then, they can send requests to insurance providers and confirm approval before the patient arrives for their appointment.

When these steps are completed before the patient’s appointment, physicians can enjoy a significantly reduced administrative burden and have an easier time managing the practice’s finances.

More time and more efficient front-end revenue cycle management processes means providers get to spend more time working with the patient to create a plan for their care and administer treatment or write prescriptions in a timely manner  instead of waiting on delayed prior authorizations.

Conclusion

The need for prior authorization creates many challenges for neurologists. However, the utilization of the latest technology can significantly improve the prior authorization process and enhance revenue cycle management for neurology practices and other healthcare facilities.

Do you want to learn more about Adonis’s suite of automations and services? If so, use the link below to schedule a demo.

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