Prior authorizations are a crucial driver in maintaining clean claims in the revenue cycle. They are, however, traditionally very labor intensive. According to a survey by the American Medical Association, an eye-watering 93% of physicians reported care delays due to the PA process. Automation, specifically robotic process automation (RPA), is the answer to helping providers ensure patients are authorized for care, driving down costs and improving patient and employee experience.

Why Are Prior Authorizations So Crucial?

Prior authorizations require healthcare providers to obtain approval from a patient's insurance company before providing certain medical services or procedures. By obtaining prior permission, healthcare providers can reap several advantages that significantly benefit their revenue cycle. Here are the top three advantages:

Improved Payment Collection

Automating prior authorizations gets you paid more, faster. Prior authorizations help healthcare providers ensure that their medical services are covered by the patient’s insurance, decreasing the likelihood of claim denials and revenue loss.

Moreover, prior authorization lets providers determine the patient’s out-of-pocket costs, allowing them to collect payment during service. This can significantly reduce the number of outstanding balances and improve cash flow for the provider, ultimately leading to a more financially stable practice. By streamlining the payment collection process, providers can focus on delivering quality patient care without the burden of outstanding debts.

Reduced Administrative Costs

Automating prior authorizations reduces administrative costs. Did you know the US spends more on healthcare administration than comparable nations? A lot more - $1,055 per capita, far higher than the other OECD nations surveyed.

Prior authorizations require providers to obtain approval from the patient’s insurance company, which can be time-consuming and labor-intensive. However, the alternative to prior authorizations is denied claims, which demand even more time and resources appealing the denial or resubmitting the claim. By obtaining prior authorization, providers can reduce the likelihood of denied claims and the associated administrative costs.

Thoughtful AI starts by collecting registration data, such as demographics, insurance details, and medical history, from various systems, patient portals, in-person office intake, other healthcare organizations, and more. Our Patient Intake and Prior Authorization solutions organize this data across your practice management and EHR systems. Suppose crucial information is missing ahead of a scheduled visit. In that case, it initiates communication with the patient or other institutions to gather the necessary data, smoothing the patient’s experience and streamlining the staff’s workload.

Improved Patient Care

Prior authorizations improve patient care by ensuring patients receive the most appropriate and cost-effective treatments. At the same time, prior authorizations require providers to justify the medical necessity of the requested services, which can help prevent unnecessary and potentially harmful procedures.

Prior authorizations can also help providers identify alternative treatments that may be covered by the patient’s insurance, improving the patient’s access to care. The result? Providers can ensure patients receive the most appropriate and effective treatments, improving patient outcomes and satisfaction.

Here’s the bottom line. An effective Prior Authorization process can positively affect a practice’s revenue cycle management, increasing denials, write-offs, patient responsibility, and provider liability. Moreover, it may require additional resources to manage the process, adding to the administrative burden.

How Can RPA Help With Prior Authorization?

Considering that 2 in 5 physicians have staff employed exclusively for obtaining PA[3], it's easy to see how RPA can provide a cost-effective and efficient solution.

RPA can automate repetitive and time-consuming tasks involved in the prior authorization process, like verifying insurance coverage, checking medical necessity, and gathering documentation. This automation can significantly reduce the time and effort required to obtain prior authorization, freeing staff to focus on critical tasks like direct patient care.

Additionally, RPA can help minimize errors and discrepancies that may result in claim denials, reducing the administrative burden and increasing revenue. And then there's patient satisfaction. RPA can improve patient satisfaction by enabling providers to obtain prior authorization quickly and efficiently, allowing faster access to necessary medical services.

Here's what it comes down to. Implementing RPA can significantly impact healthcare providers' PA process and RCM. With its ability to automate tasks, minimize errors, and enhance patient satisfaction, RPA is a powerful tool that can help providers streamline operations and increase revenue. Don't miss out on the benefits of RPA – consider implementing it in your healthcare organization today!