Today, the revenue cycle of healthcare is significantly hampered due to the lack of efficiency in the prior authorization process. The impacts of the delayed prior authorization process can be felt throughout the healthcare system by providers and their staff, as well as patients, through postponements and administrative burden. Most prior authorizations are delayed due to manual workflow processes, multiple follow-up communications, or differences in payer rules, which ultimately result in lost revenue or denied claims. Fortunately, the use of automation has proven to be a revolutionary step in addressing this issue. When organizations implement automation in the appropriate manner, they can decrease the amount of time that prior authorizations take to complete, increase the percentage of approved requests, and improve the experience for both patients and providers through expediting care delivery. The following are ten of the best strategies for effectively automating the prior authorization process:
Automatically Verify Patient Eligibility
Electronic prior authorization (ePA) will automate and eliminate a significant amount of time-consuming phone and fax communications. Instead of processing authorization requests manually, automated ePA solutions provide automated electronic submission of requests directly to payors via secure electronic channels, which dramatically reduces the time associated with processing ePA requests and greatly increases the visibility an organization has into its authorization status.
Use a workflow based on relevant rules.
AI-powered documentation matching tools will enable automated systems to identify, analyze, and match all of the necessary clinical documentation that a payor requires for an authorization request. By automating the documentation matching process, the time between when an authorization is requested and when it is received is minimized, because the payor will receive all the required documentation in one submission rather than multiple submissions.
Utilize Intelligent Intake And Data Capture
Automating follow-up reminders based on payer response times will ensure that all authorizations are processed in a timely manner, and by automating this process, organizations significantly decrease the amount of time related to processing authorizations.
Predictive Analytics for Authorization Outcomes
Using automation technology, organizations can streamline their prior authorization processes by utilizing historical data to forecast the probability of authorizing a claim. The predictive analytics feature of automation systems enables healthcare organizations to identify potential areas of concern in advance (i.e., documentation, alternative treatment methods) and to take corrective action before the prior authorization request is submitted, thereby increasing the likelihood of approval.
Seamless EHR and Practice Management Integration
Automation has the ability to increase speed and improve efficiency over time due to automated reporting capabilities that provide insight into turnaround time from payers, denial trends, and employee (staff) performance. In turn, these insights allow healthcare organizations to continuously build upon existing processes and increase overall efficiency.
Automated Reporting and Performance Insights
The reasons to implement automation for prior authorization processes will ultimately result in operational efficiencies; however, they will also encourage overall healthcare provider productivity (higher costs may produce less patient satisfaction) and improve Members’ experience with Healthcare Systems.
Why Automation Matters in the Prior Authorization Process
Healthcare Providers will be able to receive approvals from Payers much quicker, thus reducing treatment delays, decreasing employee burnout from prolonged waits for prior authorization approvals, and helping with faster cash flow to support the growth of Healthcare Organizations. As payer requirements continue to increase in complexity, it is becoming more unmanageable to continue relying on manual workflows in order to execute the new requirements of health plans, making automation a necessity for Healthcare Organizations to remain compliant, accurate, and responsive to the demands of the current healthcare system. Working smarter rather than harder is the key to reducing delays associated with prior authorization, which can easily be accomplished by implementing some of the automation strategies highlighted above. The Automation of Prior Authorization processes has become essential to deliver timely care, retain volume and revenue, and continue to remain competitive in today’s healthcare environment.