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Bizdial’s Cloud-Based Web App Solutions are Revolutionizing Pre-Certification Processes at Payer Connect
In the past 24 months, millions of Americans have had to delay/cancel their hospital visits. Due to the COVID19 pandemic, doctors were prioritizing the health and protection of at-risk patients over others.
These delays were frustrating, but they made sense. Currently, vaccines and safety protocols are helping doctors resume appointments as usual. But, thousands of patients still face delays every day because their doctors face a different type of man-made crisis.
We’re talking about the lengthy and laborious precertification processes that all patients and doctors have to undergo. At Bizdial, we’re focused on providing customized solutions to doctors’ offices & hospitals that want to optimize these lengthy precertification processes.
We believe that digitizing the precertification or preauthorization process is a critical need in the healthcare industry. Let’s explore the challenges patients and doctors face due to archaic and time-consuming precertification processes.
The Key Problems with Time Consuming Pre-Certification Processes
What is Precertification?
Precertification (also known as preauthorization or prior approval) is a mandatory process that all healthcare service providers have to observe. It’s the process of securing approval from your health insurance company to obtain treatment or a prescription from your doctors.
- Physicians decide which procedures, consultations, tests, and prescriptions drugs you may require when you visit their office. The physicians will determine what type of health plan is suitable for you based on a thorough diagnosis.
- Most health plans require precertification. Your health insurer will determine whether you qualify for the prescribed health plan based on your existing health insurance policy/plan.
- Precertification isn’t a guarantee that your health insurance policy will cover the costs of the healthcare plans prescribed by your physicians. Many healthcare services or costs may not be covered in your existing health insurance policy.
- Investigating each coverage requirement and limit is a time-consuming process. Precertification processes can take up to five to six weeks.
- Professionals overseeing the precertification process at the doctor’s office may need to supply piles of medical data to your insurers. Your insurance company may also demand photos and other information detailing your medical necessities before giving you the certification.
Unfortunately, the physicians surveyed by the AMA are not alone. Another survey revealed that 84% of healthcare professionals believe the burden of precertification processes is extremely high. 86% of surveyed physicians also said that the liability of precertification processes has worsened over the past five years.
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The Costs of Lengthy Precertification Processes
Although healthcare providers have employed prior authorization processes for many decades, little is known about their costs. For many physicians, lengthy precertification processes are taking away the time they spend caring for their patients. According to this survey by the American Medical Association (AMA)
94% of surveyed physicians stated that the precertification process delays patient access to essential care.
79% of surveyed physicians stated that precertification processes could lead to treatment abandonment.
9% of surveyed physicians reported that lengthy precertification processes have led to patients experiencing permanent bodily damage and disability.
On average, physicians and their support staff spend 16 hours per week completing precertification processes.
Impact on Doctor’s Earnings
Failure to obtain proper certifications can have a radical impact on the practice’s income. No certification means no payment from the patient’s insurance agency. Health insurance agents don’t pay for procedures if the correct pre-certifications aren’t received.
Doctors also have to follow strict contracts that restrict them from billing their patients before obtaining pre-certifications from their insurers.
Overall, long and drawn-out precertification processes result in lost revenue for doctors. Doctors are also unable to provide satisfactory care to their patients due to these administrative delays.
Impact on Patients
The long wait times to complete precertification processes harm patient experiences. The real impacts of manual precertification processes are felt by patients who fail to receive timely medication or treatment. Patients and their family members also feel confused when their precertification processes experience interruptions.
They’re tasked with determining the core reasons behind their rejections. Who made a mistake – the doctor, the pharmacy, or the insurance company? These are the questions patients in desperate need of medical care have to answer.
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