UPDATE: The American College of Radiology (ACR) announced on June 9, 2021, that United Healthcare responded to their (and other stakeholders’) request to simplify their prior authorization criteria as it relates to “specific tumor types and clinical scenarios”. These changes will be used to support determination of medical necessity, streamline processing of prior authorizations, and reduce the need for peer-to-peer conversation.
Obtaining prior authorization continues to be an ongoing struggle for most radiology groups today. The process is labor-intensive and time-consuming, often requiring many hours of constant follow-up by your staff that takes time away from patient care. From the initial determination, there are multiple risks for delays and denials—so in 2021 how can you improve your patient access by enhancing and automating your prior authorization process?
To proactively address the multi-layer issues surrounding preauthorization, it’s helpful to identify the challenges you’re currently experiencing in the overall prior authorization process. Once those have been isolated, then rethinking your workflows and zeroing in on a solution becomes more effective.
With a deliberate and strategic approach, you can improve patient access and see benefits in the healthcare billing lifecycle workflow, including:
- Prior authorizations processed in real-time
- Clarity in patient appointment scheduling
- Lower denial rates
- Increased revenue
- Improvements to AR and Days Outstanding
- Decreased patient abandonment rates
Identifying Your Challenges in Prior Authorization
While understanding the challenges surrounding prior authorization is incredibly important, specialty practices, such as radiology, are also reliant on the ordering providers—providers who are feeling equally overwhelmed by insurance payer requirements and prior authorization guidelines. In this payer-defined environment, radiology groups must be proactive in recognizing their strategic approach to workflows, as well as healthcare system and provider partnerships.
The Impact of Workflow
If you haven’t already established best practice workflows, now is the time. Experience shows that an automated and stage-oriented comprehensive model with a goal of over a 99.5% accuracy rate is achievable through artificial intelligence (AI) driven software and should be the bar to strive towards.
To use AI-driven software to automate the PA process, increase revenue, and reduce overall administrative costs, a system needs to be able to do the following:
- Determine the need for a prior authorization and, if required, initiate the process in real-time.
- Determine the need for a PA, and, if required, initiate the process in real-time.
- Obtain a complete, authorized prior authorization in real-time delivered to the scheduling team.
- Follow up on incomplete prior authorizations and automatically resubmit or appeal as required.
Starting on a Solution Today
Going automated and electronic is inevitable; the entire healthcare industry is moving towards advanced prior authorization solutions that ensure patient access and improve patient outcomes. Even with United Healthcare making changes that benefit provider practices, healthcare systems and providers now have tools to proactively streamline the prior authorization process and take control of the management of their revenue cycle.
Through comprehensive workflow management, business analytics dashboards, and cross-team communications that facilitate information, your radiology practice would benefit from state-of-the-art software, driven by AI and automation, to enhance your healthcare billing lifecycle. Through enhanced patient access and revenue cycle management, your practice would recognize a stronger bottom line and significantly improved patient experience.
Request a demo today and learn how an AI-enhanced software solution can simplify your prior authorization workflow for radiology and increase cash flow in your practice.