Physicians know all too well about the headaches and heartaches associated with prior authorization (PA) in medicine today. Here’s a handy glossary—or perhaps a devil’s dictionary—to help guide you through the madness, with pointers to how the AMA is fighting to make a big dent into this time-gobbling payer practice that delays your patients’ access to care.
Prior authorization is a health plan cost-control process that restricts patient access to treatments, drugs and services. This process requires physicians to obtain health plan approval before delivery of the prescribed treatment, test or medical service in order to qualify for payment.
According to an AMA survey of 1,000 practicing physicians, more than nine in 10 respondents said PA had a significant or somewhat negative clinical impact, with 28% reporting that PA had led to a serious adverse event such as a death, hospitalization, disability or permanent bodily damage, or other life-threatening event for a patient in their care.
My latest at the AMA. The whole shebang.