There’s nothing new about prior authorizations or the frustrations they cause in day-to-day operations within most orthopedic practices. They are required for many orthopedic surgical procedures, and for rehabilitation services and advanced imaging tests often used as part of the orthopedic diagnostic process.

Even though everyone in healthcare seems to be aware of the problem and every organization from the AMA to the MGMA has lobbied insurance companies and Congress to affect change, little has been done. Prior authorizations are growing more prevalent as new and advanced surgical procedures, testing options, and medications become available.

Have You Considered Leveraging Advanced Automation?

The best solution, it seems, is to employ advanced automation as a way to manage prior authorizations more effectively and manage the workflow that is now dedicated to a manual process.

We know for sure that most practices use a mostly manual system to process their prior authorizations. According to the 2020 CAQH Index, Closing the Gap: The Industry Continues to Improve, But Opportunities for Automation Remain, only 21% of practices use a fully automatic prior authorization process, instead of relying on phone calls, fax machines, and hours of employee time.

What Does a Prior Authorization Automated Solution Look Like?

When using a tech-enabled service solution that combines artificial intelligence (AI) driven software with certified specialists, like Infinx’s Prior Authorization Software solution, that integrates with your EHR/EMR, your prior authorizations can be processed in near real-time. And when complex or emergent prior authorizations are required, certified experienced specialists step in to shepherd each request through the system, ensuring no roadblocks occur, providing you with an end-to-end prior authorization solution.

Consider these five ways that your prior authorization process is improved using an automated system:

  1. Initial Processing — From the moment patient information is entered into your EHR/EMR system; guided processes are monitored for the key identifiers to initiate prior authorization approval. Matching ordered procedures, tests, or medications with constantly updating insurance prior authorization requirements, the system stands ready to gather the required information and initiate the requests in real-time. Business and clinical staff no longer have to manually process forms, wait on hold, or fax repeatedly can refocus their time on higher-level functions.

  2. Continual Follow-Up — Once the prior authorization approval is submitted, electronic follow-up occurs 24/7 until a final resolution is obtained. If additional information is required or an appeal is necessary, the practice is notified immediately so that a response could be crafted and submitted as soon as possible.

  3. Dashboard Notifications — Waiting for insurance payer responses has historically been a time-consuming affair that took hours of follow-up and burdensome administrative effort. With an interactive dashboard, today’s AI-driven software gives a complete snapshot and clarity on all active prior authorization requests so that patient and clinician questions can be answered immediately, and follow-up can occur as necessary.

  4. Scheduling — Alleviating the frustrations of having to schedule and reschedule patients based on prior authorizations, your practice has more accurate parameters allowing a more efficient process for everyone. This improves the patient’s experience and allows your providers to focus on patient care.

  5. Analytics and Reporting — Bringing full transparency to future operations, timely analytics, and reporting pinpoint breakdowns in efficiency or areas needing improvement. This allows your practice to reallocate workflows to other areas to allow for more work to get done overall.

An Added Bonus: Fewer Denied Claims Due To Prior Authorization Issues

As a bonus, with fewer prior authorization problems comes far fewer rejected or denied claims and more revenue hitting your bottom line. You have a much more efficient A/R process and fewer Days Outstanding for amounts due. Infinx has AI-driven software that handles denied claims in a manner similar to prior authorization, with a >95% quality standard.

To Sum it All Up…

Today, most other functions in an orthopedic practice are at least partly automated. But prior authorizations, as a whole, have been slow to embrace technology. Orthopedic practices would be well served to investigate the financial investment; the benefits would far outweigh the costs when you consider that prior authorizations that used to take several hours to days with multiple follow-ups can now be done electronically in near real-time.

The savings in staff time, the reduction in provider and patient frustration, and the increase to the bottom line due to reduced denials and recaptured patients (who often switch practices due to delays caused by prior authorizations) would be well worth the investment.

Contact Infinx today to request a demo and learn more about the efficiencies gained through automating your orthopedic prior authorization workflow.