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Automating Prior Authorizations

Prior authorizations no longer have to be headaches

For most practice managers and radiology pre-certification specialists, time is money—any chance to reduce daily demands means more time to focus on building practice revenue elsewhere. Managing authorizations manually is one task that consumes time and affects patients waiting to have a procedure scheduled. Mistakes in the prior-authorization process trigger a denial, and even more time to research the claim, correct the authorization, and file the appeal to recover the lost revenue.

Prior authorizations appear to be a relatively simple process on the surface, and follow three steps:

  1. Determining if the auth is required
  2. Submitting the authorization
  3. Obtaining the status from the payer.

Yet pre-certification experts know each step above is often a maze of payer portals, fax forms, phone calls, sticky notes, and long wait times for your staff and patients. Unless your practice has built one, authorizations don’t come with a manual or helpdesk for special circumstances or complex authorization issues.

But times are changing—new solutions automate some or all of these steps. Chilmark Research recently published a market report on advancements in prior authorization technology and predicted that “providers…will see new solutions that will make prior authorizations more effective and efficient so [authorizations] can more broadly serve as a vital aspect of revenue cycle, cost containment, and population health management strategies.”

Reducing an authorization process from days to minutes through automation speeds up scheduling, improves patient satisfaction, and frees up staff time to work on more high-value activities. And for radiology practices, where referrals are the primary source of scheduled procedures, streamlined authorizations processes can be a competitive advantage.

With shrinking reimbursement and tight margins, it’s more important than ever to operate at optimal capacity. A last-minute cancellation because of a missing or denied authorization not only means lost revenue for that procedure, but now you have expensive equipment and highly paid clinical staff sitting idle. Getting pre-authorization confirmations more quickly allows your organization to keep your schedule current and minimize cancellations.

It’s time to leave behind the old, inefficient authorization processes that are costing you time, money, and patient satisfaction. Availity can help.