AI, the Flywheel Effect and an End to Prior Authorization Friction on the Frontlines

By Infinx
January 15, 2019

The frontline for prior authorization problems is a very frustrating place. That’s where front desk personnel and patient access specialists inform patients of appointment cancellations, delays and denials. It’s the kind of organizational friction that creates a major medical practice burden.

How major? Practices spend an average of two business days a week per physician to comply with health plans’ inefficient and overused prior authorization protocols, according to a recent AMA study. One-third of practices employ staffers who spend every second of their working hours on prior authorization requests and follow-ups. What’s more, 92 percent of physicians said prior authorization delays patients’ access to necessary care.

While it’s common knowledge that prior authorization snafus won’t boost patient satisfaction scores any time soon, they can also negatively affect your ability to hire and retain front desk personnel and patient access specialists.

AI and The Flywheel

A flywheel at rest needs a good push to get spinning. Once in motion, it develops independent momentum of its own. With every rotation, the flywheel is easier spin. A classic business metaphor popularized by strategy guru Jim Collins, the flywheel effect also accurately describes how artificial intelligence (AI) and automation is revolutionizing the prior authorization space — and vastly improving the work lives of countless patient access specialists.

While the AI technology employed on the patient access front is wildly complex and ever-evolving, the concept behind how it works is not. By identifying procedures that do not require prior authorization upfront, engineers can automate big chunks of the process. Once the flywheel is set in motion, that automation immediately simplifies a complicated, manual nightmare. Yet the AI algorithm is just getting started. Like a flywheel, the prior authorization software effortlessly builds momentum. It learns from each interaction. It grows more intelligent and efficient. With every cycle it streamlines the process and the number of prior authorization delays and denials dwindles.

A Window into the Process

AI not only optimizes workflow, it also provides a window into the process for your front desk personnel and patient access specialists, by providing insight into status and activities. Having access to that kind of real-time information gives staff the ability to provide answers to patients, not excuses or shrugs.

“The toughest part of my job is having to tell patients and clients, ‘I don’t know,” said Carolyn Freener, a prior authorization manager who oversees a team of specialists at the medical front desk of a Northern California radiology practice. “It’s a huge drain on everyone involved and is probably the greatest contributor of churn in our department.”

The Importance of Culture

Fewer delays and denials directly boost revenue. That’s no secret. According to a recent report by the Journal of American Board of Family Physicians, providers spent more than $2,000 to upwards of $3,400 every year working on prior authorizations. More efficient scheduling not only means fewer wasted man hours, it means less idle machines.

Yet another very real benefit of an automated prior authorization process is improved culture. Instead of wrangling with bureaucracy, your front desk personnel and patient access specialists can start helping patients again. Don’t think this is a big deal? Eighty-five percent of employees in the world are disengaged from their job and unproductive workplaces are costing companies an average of $1 million a year for every 500 employees, according to thought leaders over at Delivering Happiness.

Only 8 percent of the industry uses some kind of electronic or automated prior authorization process at the moment. Prior authorization delays and denials cost the industry millions every years, yet solutions, like Infinx’s Patient Access Software are emerging.

Let Infinx help alleviate organizational friction at your medical front desk. Contact us today to learn more about our solutions.

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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