Simplifying The Prior Authorization Challenges

Driving Your Prior Authorization Efforts

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.

Company Outline

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

Caused by:
Lack of adequate staffing
Delayed submission of authorization
Absence of proper follow-up
 Non-trained staff
Caused by:
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
strategic directives

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.
PROCESS STABILITY:
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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What Customers Say

  • Thank you again for your efforts - your team continues to meet our expectations and is actively improving our ability to serve our patients. Your efforts specifically to maintain open communications with our team has fostered the success of this effort and we look forward to expanding the effort next week and beyond.

    Project Manager at a leading Prosthetics & Orthotics company based in Florida
  • I was always against the idea of outsourcing our back-end claims processing work but I was wrong. You have provided extraordinary deliverables on a timely basis which led to cost cutting considerably for us.

    CEO of a leading MA-PD Plan
  • We upload charts to a secure FTP server and they take it from there. The staff is knowledgeable and very easy to work with. Any issues that we have faced have been resolved within a few days.

    A major orthotics & prosthetics practice based in the south-east