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Why Prior Authorization Is The Number One Use Case For Automation Across Healthcare Group Offices And Practices

Prior authorization is an essential aspect of the healthcare industry through which medical service providers get approval for treatment through various health insurance plans. It remains a significant burden for medical organizations, professionals, and insurance providers due to tedious processes that delay the provision of medical care to patients who need them. 

Even if the prior authorization requests are initiated the traditional way, there is no guarantee that there will not be any denials and issues that have adverse implications on patients’ health. With such complicated procedures, it is crucial that prior authorization processes need to be automated for the efficient management of healthcare practices. 

Learn why prior authorization is the number one use case for automation across healthcare group offices and practices in this article. 

Benefits Of Prior Authorization For Automation In Healthcare

Automation in prior authorization for healthcare offers a wide range of benefits for the medical industry and the general public. Here are the specific benefits that revolutionize the prior authorization process and improve the processes in the healthcare sector. 

End-to-End Tracking Of Authorization

Automation helps in end-to-end tracking of the prior authorization processes, such as through the RPA (Robotic Process Automation). RPAs are specifically designed bots that follow specific steps to ensure authorization processes run smoothly. 

Reduction In Write-Offs And Denials

Prior authorization in the healthcare sector comprises tedious paperwork to fulfill specific requirements. Automation helps in resolving the issues arising in the medical systems during prior approval and ensures compliance with legal requirements.

In addition, prior authorization in the traditional way increases the risks of denials and up to 30% easily preventable write-offs. Therefore, automation can decrease the risks of denial and write-offs significantly. 

Improvement In Accuracy And Profitability

Automation tools in the prior authorization processes improve accuracy and profitability in the healthcare industry. For example, automation can implement status checks on insurance portals when a prior authorization process is initiated so that no issues may arise.

Enhancement Of Patient Experiences

The healthcare industry heavily relies on patients’ experience, and organizations and medical professionals need to ensure that their patients are satisfied with the services offered. However, any negative experience in the prior authorization process can lead to unnecessary frustration and discourage the patient from interacting in the future. 

Therefore, automation in the prior authorization processes ensures faster and more accurate results to enhance patient experiences and offer the required medical assistance promptly. 

Updation Of Rules And Regulations

In manual prior authorization procedures, healthcare providers need to constantly check for updated forms and regulations to ensure consistent processes. Automating the prior authorization processes automatically updates the rules and regulations, saving time and reducing errors. In the present time, various healthcare software scan through different medical plans and enable patients to have a seamless experience. 

What Role Does Automation Play For Prior Authorization In Healthcare Group Offices And Practices?

In a recent survey by the American Medical Association (AMA), 93% of medical professionals narrated that prior authorization requests delay patient care, indicating that the time delays in these processes can make it challenging for patients to go through medical treatments. 

In this section, we have discussed the role of automation for prior authorization in healthcare group offices and practices to help patients have a satisfactory experience without any inconvenience. 

Benefits Of Automation

Automation in prior authorization for healthcare bridges the gap between medical service providers and payers, ensuring smooth experiences. It helps service providers have complete patient data for making proper decisions. According to a patient’s perspective, there are multiple advantages that can help them receive appropriate treatment without any delays. 

In addition, traditional methods for prior authorization might require patients to wait for several days to get their required treatment which leads to discouraging them from forgoing the treatment entirely. Medical organizations can ensure faster administrative processes generating overall efficiency. 

Solving Data Challenges

Automating prior authorization processes helps in solving issues arising from data management. Without automation, medical organizations have a significant workload with great volumes of prior authorization processes to track, which can negatively impact patients’ health. 

Moreover, prior authorization depends greatly on data exchange which can help in accurate information provided to support health claims. Proper data collection and maintenance can help with easy documentation to ensure appropriate medical treatments.

Cost Controls

The prior authorization process aims to reduce unnecessary healthcare treatment costs burdening medical insurance providers. In case of delays for prior authorization, patients might be forced to spend a significant amount of money and waste time. 

In order to avoid the arduous task of manually completing prior authorization requests for each patient, automation can be an effective solution to implement cost controls and generate efficiency. 

The Problem Of Proof

Automation plays a vital part in dealing with the problem of proof arising during prior authorization requests for several reasons, including improper documentation. Moreover, healthcare insurance providers need a standardized model to carry out prior authorization procedures leading to slow processing and multiple turnarounds. 

Therefore, automation can help with the proper collection and documentation of proof to initiate prior authorization requests faster and maintain an outstanding level of transparency for quicker decision-making.

Final Thoughts

Recently, the US Centers for Medicare & Medicaid Services (CMS) has proposed a solution indicating specific insurance payers to set up automated processes that will reduce the time frames of initiating and fulfilling prior authorization requests. In this article, we have highlighted why prior authorization is the number one use case for automation across healthcare group offices and practices. 

Moreover, if the financial implications and delays in patient care are considered, it is evident that prior authorization procedures need to change for the betterment of society. If automation can help generate efficient processing and reduce dissatisfaction, it should be introduced to healthcare practices to ensure patients get their required medical care timely. 

We hope this article will enable readers to understand the importance of automation for prior authorization in healthcare. For additional support or questions on how qBotica can support your healthcare practice, organization, or group office, set up a meeting with one of our healthcare automation experts and we’ll be happy to review solutions and services with you.