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Myndshft Blog

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October 6, 2022

3 Clear Warning Signs That You Need Prior Authorization Software

by Susan Lawson-Dawson | Healthcare Technology

You’ve probably heard the adage, “Old habits die hard.” Benjamin Franklin penned it. Mick Jagger crooned it.  And every day, your staff lives it as they continue to manage prior authorizations manually.  What’s holding you back from making the switch to prior authorization software?  If you need a list of reasons to forego the status quo, start by checking for these warning signs. 

Physician & Staff Burnout

The U.S. Surgeon General actually pointed to prior authorization paperwork as one of the factors influencing burnout among clinical and non-clinical staff among healthcare providers.  Certainly other factors contribute to burnout, including the pandemic that stretched providers resources to their limits. 

But in regular day-to-day operations, it’s the little things that wear you down. 

  • Typing the same information in multiple places. 
  • Sitting on hold to get answers about prior authorization requirements or submission status. 
  • Explaining to patients why you can’t schedule a treatment without the payer’s sign-off.

Let’s face it; no one chooses a career in healthcare for the paperwork. It’s the patients that inspire us. 

We’re already in a staffing shortage and as more Boomers age out of the workforce and competition from other industries remains high, the shortage is likely to continue. Automating this cumbersome process with prior authorization software helps you improve productivity without adding staff, while also relieving some of the pressures that lead to burnout. 

Denials Rework

Did you know that 90% of denials are preventable? The current manual process used for prior authorizations requires repetitive data entry (typos waiting to happen). In addition, incorrect CPT codes or clinical documentation that is missing or incomplete puts the brakes on prior authorization requests. Then denied prior authorizations must be reworked. Even worse, only two-thirds of preventable denials are successfully appealed, which means you’re always leaving revenue on the table. 

Plus, you’re missing the chance to prevent prior auth denials from happening in the first place and increasing expenses through the rework. Not to mention, your patients experience unnecessary care delays. 

It’s possible to eliminate opportunities for errors or missing information, helping you keep denials to a minimum and patients connected to the care they need. With prior authorization software, you enter minimal information to get the ball rolling. The software enables hands-free verification of plan and group-specific requirements, pre-checks for errors and missing information, submits the request via the payer’s preferred submission path and monitors the status in a single view. This saves you time as you avoid revisiting various payer via phone, email or portals to check on the status on outstanding authorizations. 

Treatment Delays & Abandonment 

Even if you don’t have to rework prior authorization submissions, a slow process creates its own problems. The 2021 AMA Prior Authorization Survey, for instance, revealed that:

  • 93% of providers report care delays due to prior authorization
  • 82% also report that PA ‘sometimes’ lead to treatment abandonment

Not only is that bad for your patients (and frustrating, too), but it also has a negative impact on your bottom line. 

It prevents you from engaging patients quickly. Take physical therapy. You need care continuity to get patients’ buy-in for the therapy. But if you cross your fingers for the initial assessment, you could find further treatments delayed or unreimbursed. It’s discouraging for patients and costly for you. 

Or imagine being  prepped to perform a procedure, only to learn that prior authorization hasn’t come through? The appointment gets postponed, but the expenses preparing for a procedure that’s been delayed don’t disappear. Treatment delays inject uncertainty into your revenue cycle. 

Abandonment ups the ante because you’re unable to provide the care patients need. According to 34% of the respondents to the AMA’s survey, delays in prior authorization have led to serious adverse events for patients in their care.  

No one wants the answer to “will they or won’t they” hanging overhead of patient encounters. By automating the prior authorization process, you realize real time savings that lead to fewer care delays and a smoother revenue cycle. 

Ready to see how prior authorization software like Myndshft overcomes the hurdles so you can focus on patients, not paperwork? Arrange a demo!