Prior authorizations are a critical part of the revenue cycle as they impact both reimbursement and patient access to care, and automation may help simplify the process.
Many prior authorization denials occur due to insufficient documentation and an inability to match information that is spread across different systems. By having proactive protocols in place, revenue cycle leaders can ensure better denials management processes.
To help alleviate these prior authorization denials, many revenue cycle leaders have turned to automation, and as a new report from KLAS highlights, leaders are seeing positive outcomes.
According to the new report titled “Automated Prior Authorization 2023,” nearly all interviewed organizations have seen improved financial outcomes and/or staff efficiency from using automated prior authorization.
For the 78% of respondents who report improved financial performance, the report found a few key outcomes including:
- A more efficient, streamlined authorization process
- Decreased time to approval (within 24 hours)
- Fewer denials being sent back to provider organizations
While no respondents feel their financial performance has worsened, the remaining 22% have seen no impact and have not achieved outcomes, citing authorizations being returned, not all cases being processed, and the vendor and payer failing to work together to get authorizations approved, the report said.
The report also cited a few negatives to implementing automation for prior authorizations including long implementation times, issues with electronic medical record (EMR) integration, and clunky workflows.
HealthLeaders recently touched base with Seth Katz, vice president of health information management and revenue cycle at University Health, on newly implemented technology at the organization, and Katz agreed prior authorizations are a great place to apply automation.
“Within about two months of kicking off implementation, [the program] started going to payer websites and logging requests for prior authorizations by taking that information out of our EMR. It's going very well. We're happy and we're looking to continue to expand it,” Katz said.
“You've to get creative with this. Prior authorization is a big one that a lot of people start with. It's a repetitive task. It's taking discrete data from your EMR and putting it out to a payer portal, so it's very systemic.”
And while the prior authorization process can be fairly easy to automate, it will never be a one-size-fits-all experience, he says.
“[Automation] is not a plug-and-play and it's also not one-size-fits-all. Meaning you might have a couple of different automation companies. The company you choose to help automate prior authorizations will not be the same company that we're looking at to do artificial-intelligent medical coding. You might have multiple automation vendors working at the same time too,” Katz said.
As with most things in revenue cycle, leaders must always weigh both the benefits and the risks in implementing automation.
For this report, KLAS interviewed 30 respondents from 26 unique organizations to understand their experiences using prior authorization solutions.
“Within about two months of kicking off implementation, [the program] started going to payer websites and logging requests for prior authorizations by taking that information out of our EMR. It's going very well. We're happy.”
Seth Katz, vice president of health information management and revenue cycle at University Health
Amanda Norris is the Director of Content for HealthLeaders.
KEY TAKEAWAYS
To help alleviate prior authorization denials many revenue cycle leaders have turned to automation, and they are seeing positive outcomes.
78% of respondents in a recent study said they saw an improved financial performance after implementing automation for prior authorizations.
Automation is not without its hardships. As with most things in revenue cycle, leaders must always weigh both the benefits and the risks in implementing automation.