Reduce Prior Authorization Pain for a Better Revenue Cycle Management

March 03,2017 / By Josh Knoll

Josh Knoll

The high priority task ahead for both physicians as well as the payers alike is relaxing the burden in the prior authorization.

According to the prominent organizations gathered in Orlando, Florida for the HIMSS (Healthcare Information & Management Systems Society) annual conference, the key strategic initiative now will be to implement quality checks and balances and reduce increasing costs in authorization and verification process. Reflection of a new interest with a streamlined PA effort for payers, clinicians as well as patients was quite evident.

A lackluster approach with a lengthy prior approval process has a direct impact on the patients as they have to wait for the authorization to receive the treatment. BCBLA (Blue Cross Blue Shield Louisiana) quite recently, tried to look at a number of ways that can help them reform their prior authorization process.

 

  • They wanted to give options to the physicians for improving the verification and authorization methods without a big lift in IT efforts.
  • One of the key members of their team engaged in clinical data exchange rightly pointed out that automation should be the buzzword ahead.
  • Reducing the extra noise and the unnecessary actions with phone calls as well as faxes on same PA requests are the need of the hour.
  • The electronic submission that is streamlined with an immediate notification whether the PA request is approved should be the standard objective.
  • Secure platforms that share patient information with 100% HIPAA compliance with automated EMR requests at multiple locations is the key USP.
  • ¬†Giving the providers choice and not forced to make a standard choice with software is going to be important.

A web-based survey was done by AMA in the month of December on 1000 physicians clearly suggested the toll on their patients with a time-consuming PA process. Almost 16 hours of physician time with staffs are consumed weekly on filing PA requests.

Two business days are lost as practices report to completion of 37 authorization requests on a weekly basis. Indeed, it is no surprise that the U.S healthcare industry is spending $31 billion annually on their current practices with prior authorization.

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