How to use electronic prior authorization in health care

In the healthcare industry, manual prior authorization (PA) processes have long been a cause of delays, administrative strain, and patient dissatisfaction. Lengthy calls, faxes, and paperwork often hinder access to necessary therapies, which affects the standard of care and the effectiveness of operations.

Electronic prior authorization (ePA) presents a more efficient, technology-driven approach. You can enhance drug adherence, streamline workflows, and reduce delays by automating requests, approvals, and communications. 

This guide will explore the benefits, challenges, and processes of ePA, along with the crucial role of electronic prior authorization vendors in driving this transformation. 

What Is Electronic Prior Authorization (ePA)?

Electronic prior authorization (ePA) is the digital version of the traditional PA process. It eliminates the need for manual phone or fax communication by using software tools to submit, track, and authorize real-time medication or treatment requests.

ePA reduces administrative burden and expedites treatment delivery by integrating with electronic health record (EHR) systems to assist you in promptly verifying insurance coverage and payer requirements.

Pro Tip: You may minimize disruption to your workflow by using an ePA solution that easily integrates with your current EHR system.

In addition to streamlining the authorization process, ePA paves the way for substantial improvements in your operational effectiveness and care delivery. Let's examine the main advantages of ePA as an essential instrument for modern healthcare procedures. 

Key Benefits of Electronic Prior Authorization

Both you and your patients can benefit greatly from electronic prior authorization or ePA. These advantages range from minimizing delays to enhancing medication adherence, making it an important instrument for modern healthcare procedures. 

• Faster Access to Medication: Manual PA procedures might take several days or weeks. According to the AMA, 94% of physicians report patient care delays due to PA. ePA drastically reduces this time.
• Decreased Administrative Burden: By automating the PA process, ePA reduces back-office work and increases overall efficiency by freeing administrative staff to concentrate on more patient-facing duties.
• Mitigated Physician Burnout: Simplifying workflows and automating repetitive tasks helps reduce the cognitive load on you, lessening the burden that contributes to burnout and job dissatisfaction.

Electronic prior authorization (ePA) offers measurable improvements in efficiency, patient outcomes, and administrative workload. However, even with these advantages, implementing ePA can be challenging for you as a healthcare professional. Let's explore the current state of adoption and the obstacles that still exist.

The State of ePA Adoption: Progress and Ongoing Challenges

Despite the advantages of electronic prior authorization, adoption remains uneven across the healthcare landscape. Here are the reasons: 

• Increased Awareness but Slow Adoption: Although ePA is becoming more widely known, many are only beginning to use it.
• Technology Gaps in Practices: Smaller practices frequently lack the resources and technical assistance required to implement new systems successfully.
• Dependency on Outdated Techniques: Fax and phone calls remain common, causing unnecessary delays and additional work.
• Provider Skepticism: Concerns about the accuracy, reliability, and learning curve of ePA systems contribute to slower adoption.

To overcome these obstacles, you must be thoroughly aware of how ePA processes work and the factors that influence their success—let's take a closer look. 

How Electronic Prior Authorization Works: Key Workflow Insights

You can handle the process more effectively if you thoroughly understand ePA workflows. By automating submissions and approvals, ePA speeds up prior authorization requests while cutting down on delays and human labor. Here’s a step-by-step breakdown of how the ePA process works:

The above flowchart visually represents the ePA process.

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1. Submit Request: The process begins when you submit a request for prior authorization. Usually, the ePA solution integrates with the patient's electronic health record (EHR) system to begin this request.
2. Verify Insurance: The system confirms the patient's insurance coverage after the request is submitted. This stage guarantees that the drug or therapy aligns with the patient's present medical routine.
3. Review Requirements: The system examines the requirements in accordance with the payer's guidelines following insurance verification. This phase entails determining if the requested therapy or drug meets the recommended criteria and assessing its medical need.
4. Receive Approval or Request More Information: The system either grants approval or makes a request for more information after gathering all necessary data. If the request is approved, the system moves to the next step. If more information is needed, the process may loop back to requesting more data.
5. Finalize Decision: You can finally decide on a course of treatment and carry out the recommended care plan after receiving approval.

By adhering to this automated workflow, ePA systems can speed up and improve the accuracy of the prior authorization process, which will eventually improve your patient care and cut down on delays. 

Spry, a physical therapy management software that helps clinics streamline operations, offers an integrated ePA solution that allows you to track prior authorization status directly within the patient's EHR. This gives real-time insight into approval timelines and eliminates the need for follow-up calls.

This automated workflow streamlines the process and reduces the time spent on manual tasks. Next, let's explore how choosing the right ePA vendor can make this transformation more effective. 

How to Choose the Right Electronic Prior Authorization Vendor

The successful and seamless integration of electronic prior authorization (ePA) in your practice depends on your choice of electronic prior authorization vendor. Here are the key factors to consider when selecting an ePA solution:

1. Seamless EHR Integration: Ensure no manual workarounds or workflow interruptions when the ePA system interacts with your current electronic health records (EHR).
2. Real-Time Processing Capabilities: Seek suppliers that provide Real-Time Benefit Check (RTBC), which grants immediate access to coverage and formulary data to facilitate quicker and more precise prior authorization determinations.
3. HIPAA Compliance: Security should be a top priority when choosing a vendor. To safeguard private information and secure sensitive patient data, ensure the ePA solution conforms to HIPAA regulations.

Pro Tip: Ask potential electronic prior authorization vendors how frequently they update their systems to comply with changing payer requirements.

For instance, Spry provides an all-inclusive physical therapy management system incorporating ePA functionality. With intuitive dashboards and real-time updates, Spry helps clinics minimize manual tasks, streamline prior authorizations, and enhance patient care efficiency.

As we conclude, let's summarize how embracing ePA can revolutionize healthcare practices and improve patient outcomes.

Conclusion

Electronic prior authorization, or ePA, is a revolutionary development in the healthcare industry today. ePA increases patient access to care, decreases administrative responsibilities, and reduces delays by automating the prior authorization procedure. 

With advantages like quicker access to medications, lower prescription abandonment rates, and improved provider-patient cooperation, electronic patient administration (ePA) is an essential instrument for enhancing operational effectiveness and healthcare outcomes.

Spry, a leading physical therapy management software, offers an integrated ePA solution to streamline your prior authorization workflows. With Spry, you can reduce manual labor and enhance patient care delivery through real-time updates, user-friendly dashboards, and seamless integration with your EHR systems.

Are you ready to improve patient care and clinic efficiency? Discover how Spry can help streamline your prior authorization process and support better healthcare outcomes.