8 Unforgettable Movie Quotes that Remind Us of the Importance of Prior Authorization Software
Prior authorizations. If just reading the words gives you a sense of dread, we get it. Prior authorization administration is rarely what anyone would call fun. But with the holidays upon us, we thought a more lighthearted perspective was in order. So, without further ado, here are some familiar movie quotes that seem well-suited to a conversation about prior authorization software. (Bonus points if you can name each movie associated with a quote. See list at the end.)
Time will not slow down when something unpleasant lies ahead.
Okay, we all know that prior authorization administration is unpleasant…Voldemort-level unpleasant. But most patients don’t understand what providers go through to get services or medications approved. All they know is that they need care without delay.
I feel the need—the need for speed!
From the front desk to the back office, time is of the essence because prior authorization backlogs lead to care delays, treatment abandonment, and unreimbursed claims. That’s not good for patients or your bottom line. But speed only comes when you remove the barriers—and one of the biggest is featured in our next quote.
What we’ve got here is a failure to communicate.
With more than 1,000 payers nationwide—each with numerous plans and policies—determining whether prior authorization is required and what needs to be submitted can be a challenge in itself. Providers end up relying on a mix of inefficient options to prepare prior authorization requests:
- Payer “bibles”: Handy to have, but hard to keep current, binders can keep payer policy details nearby, but finding the needle in the haystack takes time. Plus, payers change requirements pretty often, increasing the chance that a missing detail could turn into a denial that needs to be reworked.
- Institutional knowledge: Staffers who know a payer like the back of their hands. Great, when you have them, but what happens when your “Blues Guru” calls in sick, takes vacation, or retires?
- Phone calls: Tracking down answers requires persistence and patience because there’s a good chance that your staff will be stuck on hold while waiting to talk with a payer’s representative.
What’s more, interoperability isn’t where it needs to be for fluid communication. Prior authorization software removes the communication barriers AND simplifies data retrieval so that a process that typically takes 30 minutes or more can be completed in less than 5 minutes.
You’ve got to ask yourself one question: ‘Do I feel lucky?’ Well, do ya, punk?
You attach the last piece of documentation and upload a prior authorization request to a payer portal. Or maybe you send it off via fax. Either way, once it’s headed to the payer, this quote could very well spring to mind. When you’re handling prior authorizations manually, every smooth approval can feel like a lucky break.
I’ll be back.
Claim denials have been on the rise since 2020. Analysis by the Kaiser Family Foundation (KFF) found that payer denial rates range from 1% to more than 30%, with an average denial rate of 18%. Of course, not every one of those is related to prior authorization, but a good portion of them are. Here’s the real kicker: According to the Medical Group Management Association (MGMA), 90% of prior authorization denials are preventable. So, you’ll be back alright, reworking preventable claims.
With prior authorization software, the automated process ensures the right information appears in the right form with the right attachments. No good luck charm required to reduce claims rework by up to 90%.
But when prior authorization requests are denied, there are several common reasons, which explains why the next quote made our list.
Round up the usual suspects.
Troubleshooting denial causes is a must, so much so that a multi-state physical therapy provider created a prior auth triage role. The triage person focused exclusively on diagnosing causes for denials and shared the information across teams to enable proactive denial management. What are common repeat offenders?
- Missing, incomplete or incorrect data such as a patient ID number or CPT code
- Ineligible or terminated insurance coverage
- Disputes over medical necessity or completion of “steps” to validate medical necessity
The problems aren’t always tied to the specific prior authorization submission; if an error or omission occurred during patient intake—even in patient-provided documents—it can impact claims down the road.
Bye, Felicia.
Isn’t that what we’d all love to say to time-consuming, manual prior authorization? Of course, there’s another movie quote that comes to mind here too. “Say hello to my little friend.” Unlike Scarface, however, the ‘friend’ we’re referring to is prior authorization software. It helps you automate repetitive data entry, eliminate preventable denials, and connect your patients to the care they need, sooner. Which leaves us with one final quote.
It’s not enough to be against something. You have to be for something better.
The administrative burden of prior authorization frustrates everyone involved. Are you ready for a change? Arrange a Myndshft demo to see prior authorization software in action.
(Quoted movies, in order of appearance: Harry Potter and the Goblet of Fire, Top Gun, Cool Hand Luke, Dirty Harry, The Terminator, Casablanca, Friday, Captain America: Civil War)