The demand for accessible, convenient outpatient procedures is growing. At the same time, ambulatory surgical centers (ASCs) are contending with climbing costs and exceptional staffing challenges. Holdups and complications surrounding constantly changing payer prior authorization (PA) requirements add another obstacle to efficient operations. In this post, we explore the challenges of managing PA, explain the tangible benefits enlisting help from technology, and offer three actions ASCs can take to clear bottlenecks.
Like employers in virtually every industry, ASCs are seeking to maintain efficiency in the face of an unprecedented workforce exodus. Meanwhile, payers increasingly require medical providers to obtain pre-approval before agreeing to cover services. Designed to control costs for payers, PA measures often create time-consuming administrative challenges for providers. Policies differ across payers, and lean-staffed ASCs quickly can become overburdened.
Physicians, whose primary concern is patient care, are strained by mounting PA paperwork demands. Meanwhile, office administrators must step away from regular tasks to manually verify patient eligibility and meet payer requirements. Throughout this inefficient process — the time to process PA requests can range from one day to one month — the patient sits on their hands, waiting for access to treatment.
There is a simple way for ASCs to lighten the administrative burden, let doctors focus on providing care, and get patients the treatment they need sooner: leverage automated PA technology.
Benefits of Streamlining the Process With Automated PA
Automated technology can relieve the PA bottlenecks plaguing ASCs. Deploying a first-class, end-to-end PA tool streamlines submissions, monitors status, and updates information in real time.
A premier PA tool uses artificial intelligence (AI) to enhance its capabilities and stay on top of constantly changing payer requirements. Such a tool can automatically determine whether PA is required and if so, can rapidly retrieve electronic medical record data and populate physician-ordered lab tests, procedures, or treatments into a payer’s PA system to instantly coordinate benefits, eligibility, financial responsibility, and continually monitor the request status through determination and adjudication.
Combining a PA tool with optimized workflows and complementary technologies can go a long way toward improving operational efficiency and protecting profit margins.
Three Ways To Relieve PA Bottlenecks
Follow these steps to reduce the burden on administrative staff and physicians, control costs, and improve patients’ access to treatment.
- Apply automated PA technology to ease administrative burden. Eliminating manual prior authorization procedures can remove roadblocks to organizational efficiency.
- Reposition your workforce in roles that add clinical and operational value. Automated pre-approval increases doctor-patient face time and enhances administrative workflows, freeing staff to tackle important tasks.
- Explore how accounts receivable (AR) optimization technology can complement automated PA. Demographic enhancement and eligibility tools can automatically discover and verify patient information and active, billable coverage from the get-go, reducing manual tasks and improving revenue cycle efficiency throughout the patient encounter.
To learn more about how AI-enhanced PA technology can optimize the authorization process, reduce staffing demands, and protect profit margins, read the article: ASCs Are Urgently Seeking a Path To Relieve Prior Authorization Bottlenecks.
Read more about automated prior authorization: Automated or Manual Prior Authorization: What's Right for You?