Let’s face facts, every medical practice, whether primary or specialty care, struggles with the ongoing burden of prior authorizations (PAs) and the added administrative workload placed on providers.  Without a doubt, PAs create the single most significant requirement for practices trying to manage the overwhelming paper flow to meet insurance payers’ guidelines and requirements and ensure patients receive the care prescribed.

Recently, the American Academy of Family Physicians (AAFP) published its Agenda for Regulatory and Administrative Reforms, where PAs were named as the single biggest problem when it came to time and resources used that would be better spent on patient care.  Further adding stress to the system is the fact that only 12% of PAs are processed electronically today, leaving far too much manual administrative time wasted through employees on hold, faxing, and various other PA-related manual processes.

5 Improvements to the Prior Authorization Process

While there is a desire to make sweeping changes to the insurance-dictated PA system for a variety of reasons, little has actually changed—PA requirements are only growing and expanding. With this in mind, let’s focus on changes or improvements that practices can make now that will have a significant impact on their workflow and patient experience both in the short term and into the future.

Automate Your PAs!

It seems like a misnomer, but according to the recent 2020 CAQH survey, while claims submissions and claim status inquiries are processed electronically by 96% and 72% of practices, respectively, PAs lag far behind at just 21%. Practices that consider automating their PA process not only gain administrative time and reduce physician frustration but also greatly reduce the costs associated with managing the PA function.

Today’s automated PA solutions bring Artificial Intelligence (AI) driven software with machine learning capabilities that process, submit, and follow-up on PAs in real-time.  They also use cloud-based technology and offer expanded functions such as insurance verification and patient pay estimation to form a well-rounded patient access suite.

Keep Patients Informed

Healthcare professionals industry-wide are focusing on improving the patient experience in answer to consumers’ increased financial participation.  More and more patients are taking a more active role in their care, driven by being responsible for the cost.

PAs represent an opportunity for practices to strengthen the patient experience and increase patient loyalty by educating the patient on the process and keeping them informed of the outcome.  With automated PAs, approvals can be obtained in real-time and patients scheduled almost immediately without having to wait.

Know Your Key Procedures

Every practice has certain procedures, tests, or medications that trigger PA requirements.  Design a clinical flow that isolates those procedures needing special treatment so that they can go immediately into the PA pipeline process.  Once processed, outlying requirements notwithstanding, they are ready to be executed and approvals obtained to streamline patient scheduling and care advancement.

Have a Practice PA Expert

Whether a practice administrative specialist or a member of a third-party PA/billing team, it is important to have an expert where all PA issues are funneled.  AI-driven software can handle the vast majority of approvals, but there will invariably be emergency or complex PAs that require special handling.  Having a system to handle those approvals quickly and efficiently makes for a well-rounded, streamlined PA process.

Integrate Your EHR

Today’s EHR/EMR systems typically have alerts and can suggest alternative treatments, therapies, or drugs that may not require PAs.  Research your record capabilities and configure the system to alert you to possible alternatives saving everyone time and frustration.  Additionally, review your analytics to isolate any ongoing problems or patterns that may be adding to your practice’s workload unnecessarily.

Approaching PAs proactively greatly reduces their burdensome effect.  At least until there are industry-wide improvements, automating your patient access process is often the single biggest area for streamlined workflow and reduced overall administrative costs.

Contact us to learn more about managing PAs electronically.