Simplifying The Prior Authorization Challenges
The study followed the daily activities of 57 physicians across internal medicine, family medicine, orthopedics and cardiology. It was found that physicians spent almost 50% of their time doing paperwork, with 27% time being spent in the offices.
A recently published article in the Annals of Internal Medicine clearly found out that for every hour that an American physician was spending on seeing their patients, nearly two additional hours are getting spent additionally on tiresome paperwork.
Even while the doctors were in the examination hall with the patients, they are spending only 53% of their time actually seeing the patient while 37% was spent…you are right …doing paperwork! Delays with prescription abandonment and medical procedure, countless hours being spent on prior authorization, it is important to implement a more patient centric model that helps in reaching the expectation.
Currently, we find practices spending a lot of time and money on all kinds of prior authorization that includes the preapproval of the prescriptions. Electronic prior authorization not only reduces the hard work involved but also makes the patients happier. It is possible to receive a prescription and get it approved before leaving the physician office.
The Sunknowledge Services approach for diagnostic radiology centers
Sun Knowledge services Inc. has the best plan in prior authorization with a collaborative approach, smooth process transition. The details given below outline one of our partnerships with a renowned client in diagnostic radiology. Specialized intervention provided by us helped in achieving 12% increase in the revenue with a reduction of 50% in operational expenses.
A leading healthcare provider in Indiana. They have contracts with Medicare and Medicaid. Also, have commercial contracts with Aetna, BCBS, Cigna and UHG etc.
Their key services: Diagnostic imaging exams, including PET/CT, MRI, CT, Nuclear Medicine, Mammography, Ultrasound, and X-ray
Prior Authorization process involved
|An ECW system called the jellybean is used to task the process of prior authorization. The authorizations are initiated and documented in the ECW system. With a valid call reference||payer communications are documented.|
|After authorization approval||payer communication is uploaded in the ECW system after receipt post which the services are rendered.|
The Pain or Conflict
Poor realization of prior authorization despite significant growth in the patient base
Lack of adequate staffing
Delayed submission of authorization
Absence of proper follow-up
Operation reports lacking
Focus to give clarity on day to day activity
Full visibility on each authorization submitted,
Lack of call reference no. on approval for validation
|Leading to: Reduced authorization approval
Inadequate data to support management’s decision making
|Leading to: Poor visibility & Reduced
The Sun Knowledge resolution
Transition performed in phases to avoid any disruptions in the current operations. The optimized prior auth process involved:
Hiring, training, and setting up of required IT infrastructure
Regular feedback and collaboration sessions
Creation of tools to improve productivity
Daily reporting mechanism
Identification of areas of improvement
Process calibration and realignment
Transparent operational and management reports
Impact of the engagement
|INCREASED PRODUCTIVITY AND REDUCED OPEN AUTHORIZATION: Removed redundant process steps to focus on the critical ones; created tools /cheat sheets, and introduced various process checks to improve productivity||REDUCED AUTHORIZATION DENIAL: Creating a system by which we are able to track the denials from the insurance companies to enforce corrective actions on future authorization requests.|
Achieved consistent and better productivity; and higher accuracy through the application of an improvement methodology
|QUALITY AND EFFICIENCY IMPROVEMENT:
Proper tracking and reconciliation; internal audit mechanism to identify and rectify errors; enforced
corrective and preventive action measures
Transition as easy as 1 2 3!!
|Improved efficiency – Significant reduction in prior authorization approval cycle through timely initiation and proactive follow-up||Improved Approvals– All authorizations to be initiated on the same day( 100%). Same day authorization approvals at 85 to 90%. Proper documentation and uploading payer communication to avoid future possible denials|
|Reduction in average cost of processing staff due to outsourcing staff arbitrage – cost reduction by 50%||Timely authorization initiation– improved cash flow
and payment realization by 10%
Significant reduction in denied authorization– increased
revenue by 12%
Sunknowledge Services Inc: One stop destination for stand out practice management/revenue cycle management
As a next gen medical billing company, Sun Knowledge services Inc, believes in working as a reliable operational extension. Versatility and competency across all major practice management/billing software, highly scalable and robust infrastructure, state of the art technology and excellent disaster management mechanisms helps us in delivering cutting edge support.
Dedicated account management approach, well defined reporting and escalation matrix are deployed to meet operational targets/adherence t o SLA. Data privacy and protection is done with extensive implementation of industry standard practices like ISO 27001:2005 & HIPAA.
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