Are you tired of jumping through administrative hoops to get medical treatments pre-certified? You’re not alone.
Working in the healthcare revenue cycle industry often feels like trudging through a giant maze laden with never-ending payer obstacle courses.
Each insurance plan requires a unique set of ninja-like moves to get paid for delivering medical care. Healthcare providers must quickly learn each payer’s rules, regulations, and technology and adapt their billing practices or they have to start the “getting paid” obstacle course again.
In many cases, if a provider skips a step or makes a mistake on their first attempt, it’s too late, and the claim will be denied. This is especially true for the notorious prior authorization process.
Ouch, right?
Plight of Prior Authorizations
It’s no secret that prior authorizations cause headaches for most healthcare providers–88% describe the burden associated with prior authorizations high or extremely high.
These cumbersome practices delay patient care and lead to administrative burnout for physicians and hospital staff. According to the 2022 AMA Prior Authorization Survey, doctors and their staff spend an average of 2 business days per week completing prior authorizations. This is time that could be better spent on patient care.
Not only are physicians fed up with healthcare insurance companies, but so are patients. More and more media outlets report about egregious insurance denials that prevent patients from receiving medically necessary care.
The government wants to fix prior authorizations too. Most US states are considering legislation to reduce the complexity of payers’ prior authorizations that waste time and delay patient care. Nearly 90 prior authorization reform bills have been considered in 30 state legislatures, with more than a dozen still under consideration for possible passage.
A few of the payer requirements that may be included in these bills::
- Quick payer response turnaround times (48 hours or less)
- Only a licensed physician in the state who specializes in the patient’s condition should be allowed to make adverse decisions.
- Once a service is preauthorized, it cannot be denied (prohibits retroactive denials)
The federal government is also tackling this issue and introduced new legislation to reduce patient harm as a result of prior authorization requirements within its Medicare Advantage plans.
It’s promising that public opinion is putting pressure on insurance companies and, hopefully, it will simplify the prior authorization process. But, from an insurance company perspective, they will still want to verify that providers are delivering quality and cost-effective medical care. This means that prior authorizations are not going away anytime soon.
However, there is still hope for reducing the prior authorization challenges that healthcare providers face today and will continue to experience in the future.
Taking the Sting out of Prior Authorizations
We’d be lying if we pretended to have a team or technology that would magically make the pain of prior authorizations completely disappear. But, we can help reduce the harm to your healthcare organization – both financially and psychologically.
“At Advantum Health, our number one priority is our clients. It’s our job to eliminate their administrative barriers to allow them to focus on what they do best: deliver top-notch patient care.” -Andrea Utterback, Vice President-Revenue Cycle Management at Advantum Health
We can jump in and provide immediate value in pre-service activities such as coverage, benefits, and eligibility verification. We have optimized our go-to-market processes so we can quickly integrate with your systems.
Your patients become our patients. Advantum Health’s client operations teams follow up on all the relevant pre-authorizations so patients can get into your healthcare facilities as quickly as possible. This includes thorough preparation, expert completion, and submission of all required paperwork.
Here are four examples of how we’ve removed the pain from the Prior Authorization process for our clients:
1. Fast-track payer information requests and approvals
Advantum Health is your fast track to the prior authorization and approvals that you need. We want to chase down We take the time-consuming tasks off your plate so you can focus on your patient’s wellbeing.
We’re revenue cycle optimization experts, especially when it comes to health insurance information and patient eligibility collection and verification. Supported by our robust proprietary technology, we efficiently and effectively streamline the prior authorization process saving you time and money.
2. Deliver intuitive dashboards and real-time analytics
Our user-friendly, real-time dashboards provide 24/7 visibility into prior authorization orders along with informative data analytics. Advantum Health’s clients cite these dashboards as a key differentiator.
“Our clients love the simplicity of our dashboards and how the data enables them to better prioritize operational changes across their healthcare systems.” -Tarun Sharma, Head of Product Development
3. Collaborate with clients closely before, during, and after implementation.
Our implementation experience sets us apart from the competition. We want to get time-to-value for our clients while delivering excellent service.
We work with our clients every step of the way, especially when it comes to automating prior authorization prioritization and documentation processes. Advantum makes it a goal to eliminate or reduce the touches required to complete an authorization, lowering the margin for error for our clients.
“From day one, Advantum’s team was amazing. Whatever we threw at them, they took it and ran with it.” – Director of RCM
4. We’ve walked in your shoes.
We know what it’s like to drown in a sea of prior authorization paperwork. Advantum was founded by revenue cycle veterans who have spent hours on the phone with payers to get claims paid.
We get it.
Advantum Health works with some of the most admired healthcare organizations to realize our mission to continually raise the quality of patient care.
Conclusion
Whether requesting approval for diagnostic imaging, specialized medical equipment or for a brand-name drug, the prior authorization submission process can waste hours of time and delay patient care.
Even with stricter payer legislation and improved automation on the horizon, many providers will still find the new processes, technology, and change management too much to handle. For those physicians, partnering with a third-party vendor makes sense.
Advantum Health has infrastructure already in place that would cripple resource-strapped providers to replicate. Getting help from an outside vendor like Advantum Health helps alleviate some of the pain of prior authorizations, enabling physicians to do what they do best: take care of patients.
Explore here to learn more about Advantum Health’s prior authorization capabilities.