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Automating prior authorization is an investment that every health care organization should consider. As the industry grapples with rapid regulatory shifts and acute staff shortages, a tailored automation strategy is key to enhancing patient care and improving operational efficiency.
This article first appeared on our sister site Medical Economics.
The prior authorization (PA) process poses a significant obstacle to the delivery of optimum patient care. It often imposes significant administrative and resource burdens for physicians and medical staff, as was noted in CNN’s recent reporting1 of UnitedHealthcare’s shift from PA to advance notification for endoscopy services.
The inefficiencies of the manual approach, highlighted by denied claims due to insufficient documentation and dispersed information across systems, underline the pressing need for intelligent automation in the PA process.
Amid an increasingly complex regulatory environment and chronic staff shortages, the pressure on health care organizations is intensifying. This is precisely where automation has shown its true potential. A recent KLAS survey found that 78% of organizations implementing automated PA have witnessed improved financial outcomes2 and a significant uptick in staff efficiency.
Proactive leaders in health care have already started to harness the power of automated PA processes, showing the industry the path to follow. The daunting pressures of today's health care climate don’t make automation an attractive proposition—they make it a necessity.
Automation in PA is much more than a tech upgrade – it’s a transformative approach capable of delivering many benefits. These include streamlined workflows, reduced approval times, and decreased denial rates, ultimately fostering a climate of transparency among patients, providers, and payers.
The financial risks are significant for those who remain on the sidelines. A 2021 CAQH report3 revealed that manual transactions in health care, including PA, cost the industry $17.6 billion. This staggering figure underlines the criticality of embracing technology-led solutions in PA.
A deep dive into PA data reveals recurring issues contributing to denials. These can range from submission delays and inconsistencies in approval criteria to understanding payer-specific requirements. By identifying these patterns, strategic automation can be incorporated into workflows, minimizing resource allocation for managing prior authorizations and allowing staff to redirect their focus to other critical areas, ultimately enhancing patient care.
Moreover, automation's role extends beyond eliminating manual inefficiencies—it accelerates the PA process. Automating routine tasks significantly reduces administrative burdens, paving the way for quicker turnarounds and faster reimbursements.
When we bring data analysis and automation together, the results can be transformative. We can significantly improve operational efficiency, turnaround time, financial performance, and patient satisfaction. This synergy is the cornerstone of an effective PA process.
Choosing a partner for automation has significant consequences. Health care organizations must find a partner who understands the intricacies of the revenue cycle and aligns with their specific needs for implementation, integration, and workflow. An effective automation partner for streamlining prior authorizations will:
Automating PA is an investment that every health care organization should consider. As the industry grapples with rapid regulatory shifts and acute staff shortages, a tailored automation strategy is key to enhancing patient care and improving operational efficiency. By adopting automation, we can effectively sidestep the administrative burdens of the PA process and refocus on what truly matters: providing the best patient care.
References
1. Howard, J. UnitedHealthcare shifts colonoscopy requirements from controversial ‘prior authorization’ to ‘advance notification.’ Published online June 1, 2023. Accessed June 21, 2023. https://www.cnn.com/2023/06/01/health/unitedhealthcare-colonoscopy-requirements/index.html
2. KLAS Research Premium Reports. Automated Prior Authorization 2023: What Impact Do Automated Prior Authorization Solutions Provide? Published online January 23, 2023. Accessed June 21, 2023. https://www.caqh.org/sites/default/files/explorations/index/2021-caqh-index.pdf
3. 2021 CAQH Index. Working Together: Advances in Automation During Unprecedented Times. Accessed June 21, 2023. https://www.caqh.org/sites/default/files/explorations/index/2021-caqh-index.pdf
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