Like a whirlwind, COVID-19 seemed to appear out of nowhere and completely disrupted the global community. Economies are stressed, industries are experiencing unprecedented changes, and governments are trying to manage it all. With astounding speed, the healthcare sector has been impacted at every level—how could the industry accommodate emergent care for patients experiencing critical (and contagious) viral infections?
In record time, hospitals and healthcare workers rallied to absorb the influx of critically ill patients. At the same time, governmental agencies and private health insurers waived fees, changed care delivery models, and instituted new coding structures. Simultaneously, hospitals and providers quickly postponed non-emergent or elective treatment and procedures as patients stayed away in droves accessing care through new telehealth alternatives.
How to Manage the Huge Backlog of Deferred Care
With many states lifting or easing stay-at-home orders and people anxious to get back to a semblance of normalcy, healthcare providers are faced with an enormous backlog of postponed care and finite resources available to provide that care. For radiology groups, this represents imaging studies and procedures for patients that often require prior authorizations (PAs) before scheduling and testing/treatment can take place.
As a solution, the American College of Radiology (ACR) sent letters on May 2, 2020, to the five largest insurance companies, United Healthcare, Aetna, CIGNA, Anthem, and Health Care Services Corp, seeking a temporary suspension of PA requirements to last until three months beyond the end of the current Public Health Emergency (PHE). Additionally, the Centers for Medicare and Medicaid Services (CMS) issued guidance to private Medicare Advantage providers to forego PA requirements, at least through the COVID-19 pandemic.
An Alternative Solution
A secondary answer, and one that would last into the future positively impacting administrative costs, bottom-line results, and the patient experience, would be to initiate a fully automated PA software solution that is integrated into the EHR/EMR. By engaging technology that brings artificial intelligence (AI), predictive analysis, and machine learning capabilities to the table, PAs would be managed in real-time through a fully integrated and HIPAA compliant interface that utilizes massive insurance clearinghouses for precise, accurate processing.
From enlisting a determination engine to ascertain if a PA is required, or not, to processing and submitting the actual PA electronically, and following up and appealing outliers, the once burdensome function that could take from several hours to several days (or weeks) would be more efficient and accurate while reducing the manual workflow currently required. Not only does this improve the patient’s experience but also reduces the hours of administrative time necessary to manage PAs manually, which positively and directly impacts the bottom-line.
An Immediate Pay-Off
Launching seamlessly and easily, streamlined and fully automated PAs would not only address the current problem of treating and processing the post-COVID-19 surge of patients, expected to last from four to 28 weeks but would provide efficiencies that would continue long after things have returned to normal in the future.
This also provides a proactive response or stance rather than waiting for commercial insurance payers to waive PA requirements, something they are seemingly unwilling to do so far. If, by chance, they ever do agree, it’s doubtful that the deferment would last beyond the three months requested by CMS—the burden of PAs would return unabated.
Contact us to discuss our fully automated prior authorization software for your radiology and imaging center group or practice.