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How We Revolutionizing Prior Authorization With Automation for a Surgical Group
Discover how a surgical group streamlined its prior authorization process with automation, reducing delays and errors while enhancing efficiency and patient care.
Table of Contents
Introduction
Prior authorization can become a significant administrative challenge for surgical groups when procedures or medications require payer approval before treatment can proceed.
For the surgical group featured in this case study, the prior authorization process relied heavily on manual work, including communication with insurance companies, eligibility and benefit verification, documentation review, and authorization follow-up.
These processes created delays for staff and patients while increasing the administrative workload associated with obtaining approvals.
The organization needed a more efficient approach that could reduce manual effort, improve authorization accuracy, and help clinical and billing teams manage the process more effectively.
Challenges for The Surgical Group
The prior authorization process began when a surgeon determined the appropriate course of treatment for a patient’s surgical procedure.
Medical assistants were responsible for contacting health insurance organizations, requesting authorization and benefit verification, and reviewing payer policies to determine whether the relevant medical codes met payer requirements.
Because much of this work was performed manually, the process could become lengthy and difficult to manage.
Manual Processing
The prior authorization workflow involved extensive communication between medical assistants and payer organizations.
Staff frequently had to make lengthy calls to payer contact centers and navigate authorization requirements before receiving approval for procedures.
According to the case study, prior authorization staff typically required 8 to 10 days to obtain authorization for high-risk procedures.
These delays could affect treatment timelines, capacity optimization, and the organization’s cash flow.
Administrative and Cost Burden
The manual workflow also created a significant administrative burden.
The surgical group had attempted to deploy larger teams to handle authorization submissions. However, missed authorizations or denials caused by human error could create additional work for billing teams.
As authorization volumes increased, staff had to spend more time on repetitive administrative activities instead of higher-value responsibilities.
Errors and Missed Authorizations
An inefficient authorization process could also result in missed authorizations.
When required authorizations were not obtained correctly or on time, patients could face unexpected bills related to medications or services.
The case study states that these issues contributed to a reduction in patient volume over time.
Payment Disagreements
The surgical group also faced challenges related to authorization requirements and patient payment expectations.
The case study references the CMS No Surprises Act and the broader need for greater cost transparency. However, existing authorization requirements still created operational challenges for surgeons and their teams.
Changes to Prescriptions
In some situations, the lengthy authorization process influenced prescription decisions.
The case study states that surgeons changed prescriptions to avoid labor-intensive authorization processes, resulting in some patients receiving medications that did not require authorization but could negatively affect their health or lifestyle.
This highlighted the importance of making the authorization process more efficient without allowing administrative barriers to influence treatment decisions.
Automating Prior Authorization for Surgical Group
To address these challenges, the surgical group turned to automation solutions from Medientsky Billing.
The objective was to streamline the authorization workflow, reduce manual work, improve accuracy, and provide staff with faster access to authorization status and payer information.
Electronic Health Records
Automation can work alongside electronic health records to support a more connected authorization workflow.
For this surgical group, the automation approach leveraged the EHR environment to provide access to patient information and support authorization-related decisions.
The use of EHR information helped connect patient records with the authorization process and supported the documentation required for payer communication.
Initial Assessment and Automated Checks
The automated process began at the point of service when clinical staff assessed a patient.
The prior authorization automation bots checked the recommended procedure or medication against relevant payer databases or portals.
This helped reduce the amount of manual checking required from staff and accelerated the initial authorization process.
Automated Authorization Applications and Updates
The automation bots were designed to handle several repetitive authorization activities.
These included:
- Completing necessary authorization applications
- Identifying gaps in documentation
- Performing eligibility and benefit checks
- Providing clinical documentation for patient EHR updates
- Monitoring authorization-related information
The bots operated 24/7, allowing authorization-related tasks to continue outside traditional working hours.
This helped reduce reliance on manual processing and supported greater consistency in authorization workflows.
Real-Time Status Checks and Alerts
Another important part of the automation process was ongoing authorization monitoring.
The automation bots could access insurance portals, submit authorization requests, and continually check eligibility and authorization updates.
When additional information or documentation was required, the system could flag the issue for medical assistants or clinical staff.
The team could also be notified when an authorization was approved or denied.
This reduced the need for staff to repeatedly check payer websites manually and helped keep authorization requests moving through the process.
Transforming the Revenue Cycle
Prior authorization is closely connected to the broader revenue cycle.
When authorization processes are delayed or incomplete, treatment can be delayed, claims can face additional challenges, and staff may need to spend additional time resolving authorization-related issues.
By automating repetitive authorization activities, Medientsky Billing helped the surgical group reduce manual workload and improve process accuracy.
The automation approach also allowed staff to spend more time on higher-value activities instead of repetitive payer communication and administrative follow-up.
Results
The implementation of prior authorization automation produced measurable improvements for the surgical group.
$100,000 in Monthly Cost Savings
By automating the prior authorization workflow, the surgical group reported $100,000 in monthly cost savings.
The reduction in manual activities, including phone calls and paperwork, helped lower administrative overhead.
The case study also reports that the surgical group experienced up to 40% cost savings in its prior authorization operations.
These savings allowed resources previously devoted to manual authorization work to be redirected toward other operational priorities.
70% Reduction in Prior Authorization Task Time
Before automation, staff spent significant amounts of time communicating with payer organizations and navigating authorization requirements.
After implementing prior authorization automation bots powered by UiPath and Medientsky Billing, the surgical group reported a reduction of up to 70% in the time spent on prior authorization tasks.
The reduction in utilization hours allowed staff to redirect saved time toward patient care and other important responsibilities.
80% Reduction in Errors
Manual prior authorization workflows can involve multiple points where information must be checked, entered, and submitted.
The automation solution was designed to verify patient eligibility, cross-check medical codes against payer policies, and identify required clinical documentation.
Following implementation, the surgical group reported that its error rate decreased by up to 80%.
The reduction in errors helped improve the accuracy of the authorization process while reducing rework associated with authorization problems.
Up to 30% Revenue Uplift
The streamlined authorization process also contributed to revenue generation.
By reducing authorization delays and increasing the speed of approvals, the surgical group was able to move necessary treatments through the process more efficiently.
The case study reports revenue uplifts of up to 30% after automation was implemented.
The improved workflow also helped the surgical group optimize capacity and create opportunities to treat more patients.
Benefits of Automation for Surgical Groups:
Beyond the financial and operational metrics, the automation project produced broader workflow improvements.
Improved Employee Experience
Automating repetitive authorization tasks reduced the amount of manual work required from employees.
This allowed staff to spend less time on repetitive payer interactions and more time on activities requiring human attention.
Greater Productivity
The reduction in authorization processing time helped improve staff productivity.
Automated checks, applications, status monitoring, and alerts reduced the number of repetitive tasks that staff had to complete manually.
Streamlined Revenue Cycle Management
Prior authorization automation connected authorization activities more closely with the broader revenue cycle.
Faster processing and fewer errors helped reduce administrative friction between clinical, authorization, and billing workflows.
Support for Compliance
The case study also states that automation helped the organization manage changing coding and documentation requirements.
By incorporating checks into the authorization workflow, the process was designed to support more consistent handling of required information.
The Future of Prior Authorization
The surgical group’s experience demonstrates how automation can transform a traditionally manual prior authorization process.
Medientsky Billing’s prior authorization automation bots were designed to handle activities across the authorization workflow, including:
- Managing authorization requests
- Confirming care plans
- Verifying eligibility
- Performing patient access checks
- Monitoring authorization status
- Identifying additional documentation requirements
The goal was to create an end-to-end process that could operate more efficiently while allowing staff to remain involved when human review or intervention was required.
Conclusion
Prior authorization can place significant administrative pressure on surgical groups when staff must manually communicate with payers, complete authorization applications, verify eligibility, monitor requests, and respond to documentation requirements.
For the surgical group in this case study, automation provided a way to address these challenges while improving operational efficiency and supporting revenue cycle performance.
The organization reported:
- $100,000 in monthly cost savings
- Up to 40% cost savings in prior authorization operations
- Up to 70% reduction in time spent on prior authorization tasks
- Up to 80% reduction in errors
- Up to 30% revenue uplift
By combining automation with its existing workflows, the surgical group was able to reduce repetitive administrative work, improve authorization accuracy, and create a more efficient process for managing payer requirements.
The case study demonstrates how intelligent automation can help surgical organizations modernize prior authorization while allowing staff to focus more of their time on patient care and higher-value operational activities.
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Highlights
- 30% of revenue uplifts after implementing automation.
- 40% of their prior authorization operations.
- 70% of the time reduction on prior authorization tasks.
Client Specs
- Location: Washington
- Specialty: Behavioral Health
- EHR: Incredible
- Average collections: 300K per month
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