In the United States, healthcare can become quite intricate and at times, proper treatment can be hard to obtain. Namely, the process of prior authorizations (PA) is a very tight bottleneck that bogs down the time it takes to be treated when using a healthcare insurance provider.
Prior authorization is a request from a provider to an insurance payer to obtain authorization for healthcare services. Originally, Although the purpose of previous authorization was to prevent wasteful spending and safeguard resources, the lengthy approval and submission procedure is a major drawback. Worse of all, 1 in 3 healthcare providers say it leads to adverse health events for patients.
How Prior Authorization is Used?
The manual process of prior authorization has several steps.
Firstly, someone must Manually verify patient insurance to determine if prior authorization (PA) is needed for the proposed surgery or service.
Secondly, you need to manually read medical charts and clinical documents to determine if they meet the guidelines for prior authorizations.
Next, someone must spend anywhere from 15 to 20 minutes per patient to manually submit the prior authorization request via fax or insurance portal.
The next step is for someone to manually contact the provider (often via email or phone) to inquire about the prior authorization’s status. If the authorization is denied, the staff must prepare all the documentation and submit an appeal letter, which can be both frustrating and time-consuming. If the request is approved, staff must manually update the medical records and clarify case status before rendering any step of patient care.
Issues With Manual Processes
The burden this places on healthcare providers is monumental. For every manual authorization request, it costs $11 and 20 minutes of time and effort wasted. For this reason, 93% of physicians claim prior authorizations cause extremely high administrative burden and 35% of providers’ organizations is responsible solely for prior permission on staff.
27% of physicians say that prior authorizations are almost always denied and a staggering 75% of doctors say that prior authorization denials have increased over the past 5 years. Unfortunately, the cost of prior authorization denials is much more than just time and money.
Every single case that involves a delay in prior authorization means that there is a delay in patient care. In the most extreme cases, patients waiting for prior authorization are hospitalized 25% of the time, life-threatening events 19% of the time, and permanent bodily damage and death 9% of the time. So how can we use modern technology to help eliminate these drawbacks?
As many as 70% of current prior authorization processes rely on manual labor, which is the main contributor to these negative patient outcomes. While 20% of doctors have the right to challenge denials of prior permission, 50% of healthcare professionals say they simply don’t have the manpower, funds, or time to do so. Orbit AI’s automated permission system is a godsend in this situation.
The Rise of Prior Authorization Process Automation
By replacing the manual prior authorization process with prior authorization process automation, as much as 82% of the process can be entirely automated. Firstly, your automated system will retrieve the required patient information from your database and then place a phone call to the insurance payers to check if prior authorization is needed for the specific service that is being requested. With this process alone, automated systems can weed out any unnecessary prior authorization requests without any chance of human error and avoid wasting your time.
Next, your authorization system analyzes out the required medical documents and determines if the patient follows the prior authorization guidelines, then fills out the prior authorization request, then submits it through the provider’s respective portal.
This technology will even follow up on this request for you, making it easier than ever to do prior authorizations. Finally, when the request is approved, Orbit AI can automatically update the medical records on the approved documents. The benefits of this technology speak for themselves though.
Final Words
AI-powered prior authorization automation cuts an average of 60% of your existing costs, and represents $449 million in cost savings in the U.S. medical industry. These whopping benefits can be seen even on a request-to-request basis. This automated technology can reduce turnaround time by 55%, reduce the costs by $9.60, and free up 24 hours per day per provider group.
Most importantly, this takes the burden off your employees and leads to improved patient experiences and better patient care. Regardless of what your healthcare business offers, it’s clear that using automated authorization technology can make it vastly more efficient. Whether you want to free up time, reduce human error, or just save money, AI-powered prior authorization automation is the solution for you.
Source: Orbit Healthcare
