- October 19, 2022
- Posted by: Steve Smith
- Category: Health Systems
Getting Acquainted with Health Systems Prior Authorization
Health Systems are large conglomerates and naturally, their prior authorization requirements are more extensive than conventional healthcare places. In the context of Health Systems Prior Authorization, one of the biggest challenges faced by providers in the network is maintaining consistent productivity and sustained efficiency in their billing affairs. This is a serious concern as inconsistent performance can actually hurt the bottom line of the business.
In the real world, building a consistently productive team of billers, coders and other ‘collection’ professionals – all of them with an equal degree of skill and proficiency – may be almost an impossibility. Take Prior Authorization, for example. It will always be noticed that some people seem to manage it better than others. The problem is, prior auth requests handled with less than optimum efficiency, can lead to undesirable outcome such as extended delays in initiating treatment, or patients abandoning treatment altogether.
Such practical obstacles compel providers to look for answers that will ensure a more consistent outcome in their prior authorization efforts. One of the best answers is to be found in engaging dedicated, specialized assistance from external quarters. Let’s take a closer look at this.
Ensuring Consistent Productivity in Billing & Collections
Staffing shortage issues, rise in minimum wages, and all the other hassles (and financial demands) of finding and recruiting skilled billing personnel to join the regular workforce, are the main reasons why a growing number of healthcare providers are choosing to walk the outsourcing path. By engaging dedicated, third-party Revenue Cycle Management personnel from external, specialized providers of medical billing services, providers are able to maintain steady productivity and sustained efficiency round the year.
In this regard, a special mention must be made of offshore outsourcing. Such remote service providers can bring about fantastic savings in operational and administrative cost as they are usually available for work at rates that are substantially lower than those in the local US market. In addition to this, there is also an overall improvement of the revenue generation cycle as providers soon start noticing a rise in collections, a drop in the denial rate and a higher first-pass rate – all of which are crucial for creating and maintaining a healthy profitability.