A Guide to Improving Your Prior Authorization Process

When you optimize the amount of information you have and maximize its timeliness, the result is more accurate claims and fewer denials.

By Infinx
November 8, 2018
11:13 am

You’ve analyzed your operations, streamlined workflow and trained your staff, yet your revenue doesn’t match the number of physicians or the patient treatment hours they log. What is going on? Where are the revenue leaks and losses you can’t put your finger on?

How to streamline your prior authorization process

Physicians across the country feel the prior authorization pain. Prior authorizations represent billions of dollars of missed revenue and millions of lost hours in productivity by physicians and staff.

In a 2017 study conducted by the American Medical Association, 84% of survey participants described the burden of prior authorization on physicians and staff as high or extremely high. Other studies have suggested that physicians spend an average of 20 hours per week and nearly $83K per year interacting with insurance plans, and fixing preauthorization issues. With the prevalence of prior authorization requirements on the rise, these numbers will continue to climb.

Here’s a brief guide to help you identify some of the gaps that may be leaking revenue in your practice.

Optimize and maximize performance

The only way to survive onerous prior authorization burdens is to optimize performance and maximize revenue through electronic prior authorization. Imagine the efficiencies that could be achieved if your workflow of manual preauthorizations could be automated. Best practices in prior authorization are built on software that delivers the following benefits:

  • Timely preauthorizations conducted at the time of patient scheduling
  • Accurate preauthorization details obtained for accurate claims
  • Automated preauthorization tasks, reducing physician admin time
  • Cloud-based tools that provide real-time data to make good decisions about patient payment and scheduling

When you optimize the amount of information you have and maximize its timeliness, the results are more accurate claims and fewer denials, which equates to more revenue.

Speed and accurate processes

Speed and accuracy is the name of the game when it comes to the prior authorization process. Without it staff doesn’t know if specific patient care is approved, physicians don’t have the information they need to schedule care, and delivery is unnecessarily delayed. Electronic prior authorization automates the process according to the patient and the treatment at hand. For example, the best software delivers:

  • 24-hour turnaround for standard prior authorization needs
  • 2-hour turnaround for emerging patient needs
  • 20-minute turnaround for STAT scheduling and treatment

Automating your preauthorization allows you to receive real-time data that you need immediately, allowing you to make good decisions about patient payment and scheduling.

Finding common revenue gaps

When you look for gaps in prior authorization processes that may be leaking revenue, look at the following functions:

  • Patient pay: Are your prior authorization processes providing the information you need to engage patients in payment plans at the time of visit?
  • Coding: Do you have professional coders on staff who know the nuances of treatments, surgeries, and imaging? Do your prior authorization systems automatically enter correct codes into the patient record?
  • Billing: Is billing created under automated and accurate prior authorization? Is accuracy built into the billing system?
  • Payors: Are you receiving the contracted amount every time?

Those are just a few of the places where revenue can be leaking from the practice. If it leaks, it can pour, so implementing a prior authorization software ensures that accurate information leads to increasing your revenue.

Automate your preauthorization process

The best solution for streamlining your prior authorization process is when they are automated for real-time decision making on scheduling patients, and reducing medical necessity concerns.

The Infinx Patient Access Software solution includes a preauthorization module, with seamless HL7 integration with your EHR, and a vast network of clearinghouse integrations. The solution is cloud-based, using artificial intelligence to optimize your preauthorization process, and human intelligence to manage the complexity of exceptions.

These are just a few of the things you can do to improve the medical practice financial tactics you employ. Prior authorization isn’t going away, but you can wrangle it to the ground and exert control over it. Your physician’s’ time, patient care and satisfaction, and revenue depend on it.

Request a demo to see how you can fully automate and streamline your prior authorization workflow with Infinx’s patient access solutions. Contact us at sales@infinx.com.

About the Author

Infinx

Infinx

Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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