Getting a Leg up on Prior Authorizations

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Authorization Matters

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Physician practices continue to add administrative healthcare payroll hours to fill demands required to manage prior authorization insurance requirements. The additional employee time on average required to submit a manual medical prior authorization for payment coverage averages about 20 minutes per request. As a result, many practices have had no option but to hire additional personnel from a dwindling workforce to oversee the time-consuming process.

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Physicians are tired of the continuous battle with sluggish revenue cycles and worsening earnings loss due to chronic approval and billing issues. The effects of growing denials, complex coding requirements, requests for additional patient medical information, and lengthy response times are clearly evidenced in the volume of patients that will abandon, or delay treatment when authorizations are difficult. Currently, nearly a third of patients eventually receive the prescribed treatments, but?40% of patients will simply accept the outcome. These numbers demonstrate that the current “cost savings” approval process results in a negative health impact for physicians, patients, and their practice. Most doctors say that prior authorizations are a barrier to providing patients with their preferred prescribed care. Revenue Cycle Management automation results in fewer patient delays and faster access to prescribed medical treatments.

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Many healthcare insurance payors require a response to frequent email requests, excessive data entry, and telephone calls prior to approving payment. The burdensome volume of manual tasks has ignited the healthcare industry’s interest in solutions. For the preponderance of medical professionals, a switch to an automated RCM is the answer to protect and grow their practice. Digitizing claims management is a step forward in winning the struggle with payor disputes and reduces denied claims. This can be as simple as implementing a web portal that processes electronic claim submission. Real-time insights and seamless EHR integration reduces denials.?Through analytics, practices that automate eligibility checks and verify benefits electronically can then identify and solve practice issues that frequently trigger regularly denied claims.

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Proving Medical Necessity and Prior Authorizations

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Proving medical necessity is frequently required prior to approval. Medical necessity means payors evaluate the patient care provided using accepted medical standards to determine diagnostic accuracy and approve or deny payment for treatment. Many insurance companies deny approval of prescribed care if it does not meet their criteria for medical necessity. Constant struggles to garner prior authorizations, changing coding regulations, and the revolving door of chasing denials for prescribed care uses provider and patient time that financially and physically challenges the practice population, and ultimately, leads to reduced effectiveness of care outcomes.

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Prior authorizations for physicians and patients often feel like an unwinnable fight for presumptively covered needed care. In many cases, if the struggle is successful, for patients and providers, it feels as if the cost of the delay, the work involved, and the stress in dealing with insurance, can lead to a bittersweet outcome.

Practices that partner with trusted automated RCM solutions speeds approvals by an average of 50%. Medical providers should ensure clear, detailed documentation of all patient care to clarify medical necessity and smooth approvals.

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Technology Solutions

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Practice saving technology evolution has become necessary to overcome the administrative limitations of manual processes that plague healthcare practices. Choosing a trusted RCM software solution that can detect billing issues prior to submission, and resolve denials effectively is critical. Automation creates a more resilient and innovative healthcare organization.

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Electronic authorizations allow instant access to a dynamic practice database with secure and compliant cloud-based storage, and continuously updates prior authorization information. The result is a reduction in staff workload, happier patients, and better protection of profits. When practices rely on manual prior authorizations, 60% of claim denials are never resubmitted even though 40% or more could have been overturned. This leads to significant financial loss. Manually addressing denials is usually slow and requires labor intensive work. With automation, pre-submission claims are reviewed and edited instantly using solutions designed to automatically check patient orders against payor rules. This minimizes the risk of errors and reduces denial rates. Claims that were previously denied can be reopened to include missing or inaccurate information. Previously denied requests can be corrected and rapidly resubmitted to quickly process appeals for reconsideration. Electronic prior authorizations are on average 90% less costly than manual submissions.

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Get your Practice Moving with Automation

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Automated streamlining of a healthcare practice is a proven advantage. AI powered tools can increase patient involvement, encourage self-service, and reduce patient wait times without compromising patient care.?Organizations can then begin to free themselves from the pressure of overwork and understaffing. By incorporating new technologies into existing workflows, providers deliver more efficient healthcare, slow physician burnout, and improve patient experience. To speed reimbursement, providers can automate patient financial responsibility calculations to inform patients of treatment costs and collect payment at the point of care.

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RCM Solutions from a Team You Can Trust

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Modern healthcare practices need automated software and comprehensive, patient user-friendly relationship tools to remain competitive. Patients now want information, and the integration of portals, remote care, and access to continuously available responsive information meets that need. Revenue Cycle Management (RCM) software simplifies the prior authorization process so your team can place their focus on providing patient care. With Virtual Officeware Healthcare Solutions partnered with AdvancedMD, automating workflows and processes surrounding authorizations, medical coding, and claims resolution means faster approvals, fewer patient delays and improved access to care.

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Looking for more information on how our RCM solution can revitalize your bottom line??Our suite of services includes cloud hosted, real-time, automated billing, flexible scheduling, secure and simple electronic charting, accurate reporting, and easy-to-use patient tools. Learn how competitive and scalable RCM solutions can help your team improve operational efficiency without changing your daily workflow or adding staff and equipment. Your practice can be moving forward with increased efficiently quickly, and with devoted support available when you need it. Contact us to schedule a complimentary demo. Our experienced team is ready to help.

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