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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
The healthcare industry is witnessing a rapid increase in the number of procedures and medications that are classified as high-risk, necessitating the need for prior authorization. Payers are becoming more stringent about patient eligibility for benefits as they focus on increasing revenue.There is a pressing need for healthcare providers, especially surgical groups, to expedite the prior authorization process for procedures and medications. Enhancing patient care and experience, optimizing capacity, improving cost efficiency, and generating revenue have become essential objectives.
Challenges for The Surgical Group
The prior authorization process begins when a surgeon determines a course of action for a patient’s important surgical procedure. Medical assistants who contact health insurance to request authorization for benefits verification and access payer policies to check medical codes against the payer’s list. This causes significant delays in relation to the patient’s condition and demands the procedure be performed immediately.
Manual Processing
The process of prior authorization is predominantly manual, requiring extensive communication and exchange of information between medical assistants and payer organizations. Lengthy phone calls to contact centers are not uncommon, leading to delays in confirming authorization approval for procedures, especially for Prior authorization for the surgical group that asked us to automate the process.On average, the prior authorization staff of medical assistants takes 8 to 10 days to receive authorization for high- risk procedures, which can cause delays in patient treatments, impact capacity optimization, and disrupt cash flow.
Cost Implications
This manual prior authorization workflow created administrative burdens, reducing operational efficiencies and creating backlogs for prior authorization staff for the surgical group. The surgeons of the surgical group tried to deploy large teams to handle authorization submissions, which lead to additional time spent by billing teams if authorizations are missed or denied due to human error.
Errors and Missed Authorizations
Inefficient authorization processes performed by their prior authorization staff resulted in unwanted shocks for patients, with missed authorizations leading to unexpected bills for medications or services. This led to reducing the patient volume over time for this surgical group.
Payment Disagreements
While the CMS No Surprises Act mandates greater cost transparency and aims to remove patients from payment disagreements, existing authorization requirements made it challenging for surgeons to meet these clinical guidelines.
Prior Authorization Requests
In some cases, surgeons changed prescriptions to avoid labor-intensive and lengthy authorization processes. This led to patients receiving different medications that don’t require authorization but may negatively impact their health or lifestyle.
Automating Prior Authorization for Surgical Group
To address these challenges, The surgical group has turned to us for automation solutions to streamline the prior authorization process.
Electronic Health Records (EHR):
Automation can leverage electronic health records (EHRs) to improve workflow and patient experience. EHRs provide real-time access to patient records, facilitating better decision-making and treatment planning.
First Assessment and Checks by Prior Authorization Automation Bots:
With our automation bots, the prior authorization process will begin at the point of service when clinical staff assesses a patient. Our prior authorization automation bots immediately checked the recommended procedure or medication against relevant payer databases or portals, reducing processing time.
Automated Authorization Applications and Updates:
Prior Authorization automation bots complete necessary applications, identified gaps in documentation, performed eligibility and benefit checks, and it also provided clinical documentation for creating or updating a patients EHR. They operate 24/7, increasing authorization accuracy rates and lowering denial rates.
Real-Time Status Checks and Alerts:
Prior authorization Automation Bots enable the surgical group to log into insurance sites, apply for authorizations, and continually check eligibility updates in real time. They flag medical assistants or clinical staff with questions or additional documentation requests, as well as notify them when authorizations are approved or denied.
Transforming the Revenue Cycle:
Intelligent automation solutions by Medientsky Billing can significantly enhance revenue cycle management for the surgical group. They decrease workload from manual tasks, improve accuracy, and allow staff to focus on higher-value activities.
Results
Cost Savings
By automating the prior authorization workflow, the surgical group has witnessed significant cost savings of $100,000 per month. The elimination of manual processes, such as phone calls and paperwork, reduced administrative overhead and allowed their staff members to focus on more critical tasks. The surgical group’s utilizing Prior Authorization automation bots has experienced cost savings of up to 40% in their prior authorization operations. These savings directly contribute to improved financial stability and resource allocation within the surgical group.The surgical group’s utilizing Prior Authorization automation bots has experienced cost savings of up to 40% in their prior authorization operations. These savings directly contribute to improved financial stability and resource allocation within the surgical group.
Utilization Hours Reduced
One of the key benefits of Prior Authorization automation in prior authorization is the substantial reduction in utilization hours. Prior to automation, their staff spent hours on the phone with payer organizations, navigating complex authorization processes and waiting for approvals.By leveraging Prior Authorization automation bots powered by UiPath and Medientsky Billing, the surgical group has streamlined the process, resulting in a significant reduction in utilization hours.On average, the surgical group reported a reduction of up to 70% in the time spent on prior authorization tasks. These saved hours can now be redirected toward patient care, enhancing the overall efficiency of the surgical group.
Error Reductions:
Manual prior authorization workflows are prone to errors, leading to delays in authorization approvals and potential financial challenges for both the surgical group and patients.Prior authorization automation solutions have proven highly effective in reducing prior authorization errors. Prior authorization automation bots meticulously verify patient eligibility, cross-check medical codes against payer policies, and ensure the availability of necessary clinical documentation.As a result, The surgical group has experienced a remarkable decrease in errors, with error rates dropping by up to 80% after implementing automation solutions. This reduction not only improves the accuracy of the authorization process but also minimizes denials and subsequent rework, enhancing revenue generation for the surgical group.
Enhanced Revenue Generation:
The streamlined prior authorization process facilitated by UiPath and Medientsky Billing directly contributes to improved revenue generation for the surgical group. By reducing denials and increasing the speed of approvals, the surgical group accelerated the delivery of necessary treatments, resulting in faster billing and reimbursement cycles.
Moreover, automation solutions enabled the surgical group to optimize capacity and treat more patients, leading to increased revenue opportunities. Reports from the surgical group indicate revenue uplifts of up to 30% after implementing automation in the prior authorization process.
Benefits of Automation for Surgical Groups:
After our prior authorization automation, the prior authorization process for the surgical group improved employee well-being, engagement, and retention. It lead to marked improvements in productivity, streamlined revenue cycle management, and ensured compliance with changing codes and documentation requirements.
The Future of Prior Authorization
By leveraging automation solutions by Medientsky Billing, the surgical group automated the end-to- end authorization process. Our Prior authorization Automation Bots handled authorizations, confirm care plans, verify eligibility, and perform patient access checks accurately and swiftly.
Conclusion
Automating the prior authorization process with Medientsky Billing enabled the surgical group to streamline operations, enhance the patient experience, and drive revenue. The utilization of intelligent automation solutions helped surgeons to stay ahead of the industry trend, transform revenue cycle management, and maximize the benefits of automation across their organization.To learn more about how automation can benefit your surgical group’s prior authorization process and revenue cycle management, consult with Medientsky Billing or explore our comprehensive guides and resources.
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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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