Introduction
Since the Medicare Advantage (MA) enrollment has grown over time, the administrative cost of MA to medical practices has also grown. Prior authorization, a cost-control process, which is supposed to reduce costs, has become one of the greatest challenges of providing timely patient care. Multiple methods of submitting applications, wide presence of personnel and large amounts of treatment delays burden practices. Survey by the MGMA (2023) of 600+ medical groups shows that MA plans are the heaviest in the area of prior authorization, exceeding commercial plans and Medicaid several times over, and exceeding traditional Medicare by an order of magnitude. This infographic examines the causes, consequences and those possible solutions to this growing crisis.
Conclusion
Medicare Advantage Prior authorizations have transformed into an impediment of efficient care delivery out of a cost-control device. This multifaceted, time consuming and repeatedly reauthorizing of the program is not only costing a lot, but is frustrating both staff and patients. Practices that basically need reformation and standardization are almost all, and it is apparent that the existing model is unsustainable. Prior Authorization Automation, gold-carding, and simplified electronic networks should be embraced, which would take the strain, and move the focus back where it should be, which is on the patient. Adopting Prior Authorization Automation from experts like BillingParadise is no more an option. It is time to lighten the administrative burden and then shift towards wiser and kinder healthcare.
