A recent survey by Experian Health* found that obtaining prior authorization for healthcare items and services remains one of the top management pain points for healthcare providers. Evolving payer guidelines make the complex process even more challenging.that’s why Automate prior authorization may be the solution.
prior authorization The process by which payers and providers determine in advance whether a health care item or service is covered. Its purpose is to ensure that the diagnostic tests and procedures provided to patients are safe, effective and of high quality. From constantly updating payer rules to navigating different payer portals to querying the status of prior authorization submissions, the prior authorization workflow involves some of the most time-consuming and expensive manual transactions. Failure to keep up with changing payer requirements can result in delayed patient care and denied claims. As one respondent put it: “Anything that automates, simplifies and refines this process would be appreciated.”
The healthcare industry has responded to the administrative burden of prior authorization through legislation and initiatives. As a result, suppliers have been able to move from a completely manual process to a more electronic and automated process.Fully electronic prior authorization has been Doubled since 2019. In 2021, 26% of healthcare providers use fully electronic transactions, resulting in an 11% reduction in spending – an estimated $184 million in cost savings.
Transitioning to fully electronic authorization can improve operational efficiency, reduce turnaround time and positively impact patient care. This article explores how electronic authorization and automation can benefit providers and patients alike.
5 benefits of pre-authorization automation:
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Access a central payer database that automatically syncs with changing payer rules
One of the most common concerns among survey respondents is being able to manage the volume and diversity of payer requirements. Several respondents said they would welcome a comprehensive solution that allows employees to track changing payer requirements.Experian Health prior authorization The knowledge base updates payer requirements in real time. Staff can check what they need without visiting multiple payer websites and manually entering data. Users also benefit from a guided, exception-based workflow that identifies whether a submission is pending, rejected, or authorized, and flags where manual intervention is required.
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Prevent costly rejections and rework claims
One respondent to an Experian survey noted, “Without pre-authorization, we don’t get paid.” Failure to obtain prior authorization is one of the most common reasons for denying a claim, according to American Hospital Association. This may occur if the patient’s treatment must begin before the lengthy authorization process is completed, or because the authorization does not cover all individual elements of the patient’s treatment. Automation ensures that all documentation and records are accurate and in place, so submissions can be approved faster. Automation also allows payers and providers to view the same account information, reducing the need for long-term negotiations on authorization status and rework requests.
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Improve operational efficiency
According to one respondent, “Insurers are increasingly requiring pre-authorization to be completed before services are provided. This takes up valuable nursing time and requires non-clinical follow-up.” As the pandemic continues, maximizing There is an increasing urgency to reduce inefficiencies. Staff shortages, rising health care costs and fluctuating patient numbers have weighed on profits. Automating prior authorization can reduce the manual burden on employees, and address the financial costs associated with wasting time and resources. Suppliers can improve these operational efficiencies by combining pre-authorized software with other automated revenue cycle tools to create more coordinated and cost-effective management processes.
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Prevent dangerous delays in care with faster prior authorization
This American Medical Association Said more than eight in 10 doctors saw patient care delayed or abandoned entirely because authorizations took too long. More than one-third of the reports found that serious adverse events occurred as a result of delayed authorization. Automating prior authorization helps ensure patients don’t miss out on essential care because of administrative hurdles.The average employee saves 16 minutes per transactionallowing them to initiate more authorizations in less time and protecting patients from the clinical consequences of rescheduling.
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Provide a better patient experience
Finally, streamlined workflows enable providers to provide patients with a smoother clinical and financial experience. An automated pre-authorization system maximizes patient flow and minimizes staff input, freeing up staff time to support patients in other matters that really require human intervention. Fewer delays and errors mean patients are less likely to be frustrated as they can see their accounts being processed quickly and carefully. When patients are certain that their care will be covered, they can focus on following their care plan without worrying about how and when they will be funded.
A simplified authorization workflow puts suppliers on the right path to getting reimbursed. But without the right process, the road can be bumpy, especially as patient volumes and payer requirements change.Learn how Automatic Authorization for Experian Health Solutions that help healthcare organizations improve revenue cycle predictability and ensure a great patient experience.
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*Experian Health Customer Survey, October 2021
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