Adopting Automation for Prior Authorization

A Vital Step for Physicians and Office Administrators to Alleviate Patient and Professional Burden

By Teri Gatchel-Schmidt, Vice President, Consulting, SYNERGEN Health
Twitter: @SYNERGENHealth

In the pursuit of delivering high-quality patient care, the complexities of healthcare management continually present challenges and regulation changes. One such example is the Prior Authorization (PA) process, which currently overloads physicians and medical staff with considerable administrative and resource demands.

The increasing burden of adapting to shifting prior authorization rules, compounded by staff shortages, poses significant challenges. The overwhelming nature of the manual PA process – which is proven to be ineffective – combined with ever-changing federal legislation, obstructs providers from delivering optimal patient care.

To alleviate the strain on their staff and ensure the provision of excellent care, revenue cycle (RCM) leaders must consider the critical importance of implementing intelligent automation to streamline the PA process.

Inefficiencies of the Prior Authorization Process

The PA system currently places an immense burden on hospital employees and patients alike. Putting aside the cumbersome manual responsibilities hospital administrations face during the PA process, the need for more standardization and differing administrative approaches often lead to fragmented information across systems, causing inequitable outcomes such as denied claims.

A recent survey conducted by the American Medical Association (AMA) discovered that:

  • 94% of physicians said prior authorizations resulted in delayed patient access to essential care
  • 89% of physicians found the requirements of PA have an adverse effect on the clinical outcomes of patient
  • 86% of physicians surveyed said prior authorization rules led to greater use of healthcare resources overall
  • 80% of physicians say PA requirements resulted in patients abandoning recommended treatment

To ease the burden on hospital staff and ensure the delivery of exceptional care, proactive healthcare leaders must address these challenges head-on with automated PA processes, setting a strong example for the industry.

Key Areas of Focus for Revenue Cycle Leaders

RCM leaders in hospital administrations must address challenges faced by their staff and the individuals they serve. Urgently, RCM leaders should thoroughly investigate and understand firsthand healthcare experiences that highlight the inefficiencies of the prior authorization (PA) process. By doing so, they can explore innovative approaches such as automation to streamline the process in a seamless and universally applicable manner.

Automation and data utilization are vital in optimizing the prior authorization process. Automating prior authorization improves turnaround time, enhances accuracy, expedites reimbursements, and decreases denials. By analyzing data on prior authorization, areas for improvement can be identified, including frequent denials and delays, ultimately resulting in enhanced outcomes for both hospital administration and the individuals under their care.

Essential IT Tools Required for Automating Prior Authorization

Choosing the right automation partner is a crucial decision for healthcare organizations. Finding a partner who comprehends the revenue cycle and aligns with specific implementation, integration, and workflow requirements is essential.

Ideally, automation should facilitate prompt prior authorization approval, monitor payor regulations to ensure process compliance, and offer transparency regarding prior authorization denials.

Advantages of Implementing Automation in the PA Process

Robotic process automation for prior authorizations automates 75% of manual tasks, boosting productivity, reducing costs by 40%, minimizing errors by 75%, streamlining workflows, and accelerating case processing. These advancements ultimately improve health outcomes for patients.

Implementing automation in the PA process improves efficiency, collaboration, and patient care. It enhances communication and accelerates decision-making. Resulting in a more effective and transparent PA process, reducing administrative burden and improving operational efficiency.