Solving the Prior Auth Problem [Infographic]

Solving the Prior Auth Problem

Don’t wait, start early to reap the benefits!

The current prior auth (PA) process is riddled with errors and inefficiency due to its reliance on manual data entry. With the introduction of new government regulations aimed at streamlining the process, now is an opportune time to explore automation.

PRIOR AUTH IS A PROBLEM WORTH SOLVING

1. Time

• Prior auth is the #1 most time-consuming transaction for providers.
• 95% of hospitals reported increases in staff time spent seeking prior authorization approval.

2. Cost

• Prior authorization is the highest-cost transaction across the medical industry.
• 84% of hospitals & health systems report the cost of complying with insurer policies is increasing.

3. Denials and Revenue Loss

• According to SSI data, there has been a 53% increase in PA denials from the beginning of 2022 compared to the end of 2022.
• The American Medical Association reports that 89 percent of hospital and health systems have experienced an increase in claim denials, which was driven in large part by prior authorization.
• One of the top 3 leading causes of claim denials is prior authorization.

4. Patient Safety

• 93% of physicians say prior authorization requirements negatively impact patient clinical outcomes
  • 82% percent of physicians report that prior authorization can sometimes lead to a patient abandoning treatment
  • 34% reported that it has led to a serious adverse event for a patient in their care

WHY SOLVE PRIOR AUTH NOW?

• New government regulations and industry initiatives are aimed at streamlining the process and utilizing technology to automate and improve the process.
  • CMS New Proposed Rule: Advancing Interoperability and Improving Prior Authorization Processes CMS-0057-P
    • Providers that implement an electronic/automated solution before the 2026 deadline are eligible for incentive payments.
  • Gold carding and state programs are expanding
    • Texas: A new “gold card” law allows physicians who have obtained a 90% approval rate for PA requests over a six-month period to be exempt from the requirement.
    • Michigan: A coalition called Health Can’t Wait is advocating for legislation aimed at standardizing the prior authorization process in order to reduce wait times, streamline communication between providers and payers, and ultimately improve patient access to care.
  • Industry pressures continue to affect revenue and expenses.
    • Labor shortages and shrinking margins
      • Hospitals are looking for ways to reduce costs and improve efficiency. Implementing automation in the prior authorization process can decrease the time and resources required.

THE SOLUTION: AUTOMATION TO THE RESCUE

See automated prior authorization process diagram.

BENEFITS OF FULLY AUTOMATED, END-TO-END PRIOR AUTH

• Eliminates >70% of manual work required for benefits verification, coordination and prior authorization—no phone, no fax, no payer portals.
• >90% less time to complete the workflow—from an average 45 minutes to just seconds.
• Productivity boost enables you to reallocate staff to more rewarding work, reduce headcount or better manage staffing shortages, improving margins and cutting per patient labor costs.
• Reduction in the administrative burden on revenue cycle teams in turn leads to improved job satisfaction and employee retention.
• Pre-checks PA requests for errors, medical necessity and missing information—saving additional rework costs associated with preventable denials.
• Reduces rescheduling and treatment delays, improving patient satisfaction and clinical outcomes.

ABOUT SSI PRIOR AUTHORIZATION

SSI Prior Authorization is a hospital enterprise-wide solution with 700+ real-time payer connections that covers anything under medical benefits, including infusion, physical, occupational and speech therapies. To see how it can help you reduce the complexity, costs, and time crunch of the manual PA or pre-certification process, learn more here or schedule a demo.