Automating the Prior Authorization Process to Reduce Time, Eliminate Inaccuracies, and Save Money

Hospitals and physician offices are forced to use a tedious and inefficient referral authorization process. Because of the number of different payers and plans in any market, there are multiple portals with varying requirements for revenue cycle operations. An obstacle to accuracy is information residing in multiple systems, making it difficult to reconcile or link to the right patient record. The workflow is clunky, error-prone, and defaults to an inefficient time drain, usually managed manually. When corrections are necessary, this loop of information gathering needs to be repeated again, adding a layer of complexity to what should be a simple process. The best way to improve the prior authorization process is to infuse an intelligent automation solution in the workflow. The manual process, which took an average of forty five click-throughs on various screens and check boxes, is seamless and requires no manual intervention!

By removing the manual redundancies in data entry, the referral coordinator is able to spend time in other tasks that require the human coordination of patient care. Workload stress and data burden is reduced because the repetition of tedious tasking is eliminated. CPT and ICD codes can be easy to key inaccurately. A simple code variation has a huge implication and causes a delay in processing the referral, causing a delay in the patient’s continued care. Automation ensures 100% accuracy and speeds up the authorization process so the patient can continue care sooner and the hospital or physician organization can be paid faster. Automation can further be used to make corrections to claims in seconds, requiring no manual re-entry of data for a small error on the part of the requesting entity. The codes are corrected and are ready to re-submit automatically.

A survey by the American Medical Association found 75% of providers reported “seeking prior authorizations put a high or extremely high “burden” on the practice.” The time associated with prior authorizations can vary between 15 minutes to 2 hours, depending on the complexity and the phone vs. portal. Multiply that times the number of prior authorizations per week and you can see the value in automating this time-laden process. Patient care is delayed by 1-3 days on average, which can be a critical factor in care coordination, or even in possible re-admissions. What was intended as a means to manage the utilization of healthcare resources: people, time and dollars, has turned into a labor-intensive, time-consuming, and costly burden, adding up to $7.00 to the cost of the data manipulation and increasing the time it takes for “dollars in the door” at medical practices and hospitals.

Providers allocate substantial staffing resources to manage re- submissions. The lack of industry standards increases preparation time. Health plans often deny prior authorization requests due to incorrect, incomplete, or inconsistent patient identification. The technology exists to make this a fully-automated process. Boston Software Systems’ workflow automation platform enables revenue cycle managers to complete routine jobs efficiently and with 100% accuracy. We have worked with revenue cycle systems such as: Epic Systems, Soarian Financials, athenahealth, Cerner, Star, MEDITECH, Greenway Intergy, Prime Suite, Allscripts, eCW, NextGen, McKesson, and more. In all applications, Boston Software Systems has been able to drive increased profitability and maintain a patient-focused revenue cycle.

Give us a call. Let’s work on automating your revenue cycle tasks, resulting in improved outcomes, reduced cost, and a happier administrative staff.

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About Boston Software Systems
Since 1985, Boston Software Systems is the dedicated leader in healthcare automation. Hospitals, health systems, and providers have streamlined data management and improved accuracy while reducing costs and administrative burden. We have worked with all of the leading EHR vendors, while optimizing usability and user satisfaction.
Our exclusive healthcare experience offers a thorough understanding of the unique challenges of HIPAA, PHI, and security. We have thousands of connections working with all applications and vendor systems, and provide 100% US-based support.

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