Prior authorization requirements are growing. The question isn’t whether or not that’s the case. Instead, the question has now become twofold, “why is this happening?” and “how do we speed up the process?”
A report from the Medical Board of Georgia showed that as many as 800 medical services require prior authorizations. A recent AMA survey found that physicians and staff members spend an average of two full business days a week dealing with the prior authorization workload. And a national survey suggests prior authorization costs the US healthcare system almost $31 billion each year (that’s around $85K per FTE, if you were wondering).
The reason? Only 12% of the 182 million medical sector prior authorizations done in 2018 were fully electronic. Cue data inconsistency, lacking clinical documentation standards, and the biggest setback of all—human error.
Given continuing cost and patient volume increases, the healthcare system must replace manual processes with technology-based solutions wherever possible. Prior authorizations are a case-in-point.
Which means the easiest and most straight-forward path is automation.
Relieving the Prior Auth Headache
Prior authorizations appear to be a relatively simple process. It’s pretty much three steps:
- Determining if a prior authorization is required.
- Submitting the authorization request.
- Obtaining the status of approval from the payer.
Easy, peasy, lemon-squeezy, right?
Wrong. Each step above is a maze of payer portals, fax forms, phone calls, sticky notes, and long wait times. And unless you’re ahead of the game and built one yourself, authorizations don’t come with a manual or a “Clippy” (RIP little guy; we truly do miss those Groucho eyebrows).
But this is changing.
Reducing an authorization process from days to minutes through automation speeds up scheduling, improves patient satisfaction, and frees staff to work on high-value activities. And for radiology practices, where referrals are the primary source of scheduled procedures, streamlining authorization processes is a huge competitive advantage.
The End-to-End Option
Automate the entire authorization process, and you’ll increase yield and net revenue, optimize resources, and decrease denials and write-offs.
But automation of such a complex process isn’t simple. Here’s an overview of content your vendor should have:
1. Medical Necessity. You need to know whether an authorization is required immediately. Your vendor should cover as many commercial payers as possible, upload their content to your EHR directly to discover NCD/LCD medical necessity requirements, and use rules to decide whether you should use standard electronic transactions or data from payer websites to exchange information.
2. Initiation. On average, a manual authorization request can take as much as 20-30 minutes to prepare per patient.
Finding a software solution that can automatically initiate and obtain authorizations for scheduled services, submit the inquiry, and confirm whether a prior authorization is approved or denied without human intervention must be a part of your automation strategy.
3. Notification. You’re required to notify insurance payers in a timely manner when a new patient is admitted. And the sooner, the better. Without automation, the probability of missing the one to two day window of notification for certain payers to create and manage an authorization record skyrockets.
But there’s no reason for that. Automating the notification of admission eliminates the potential to miss the notification window, allowing you to directly access payers that may only take notifications via a web portal.
The Wrap Up
Prior authorizations are a headache. But as long as people need care, we want to find better ways to care for them. And since you’re reading this, we’re pretty sure you do, too. (Especially if it can help your bottom line.)
Automating your prior authorization process is the only way to speed up your processes and improve the quality of care you provide.
Why? Because automation saves the hardest work for the pros. Automation does the manual processes so you can focus on the meaningful.You get a higher yield per employee and faster authorization processes, and your patients get the attention and care they deserve. A true win-win.