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October 24, 2022

Centralized Patient Intake & Prior Authorizations: The Good, The Bad & The Ugly

by Susan Lawson-Dawson | News, Prior Authorization

Do you rely on referrals for the healthcare services that you provide? Post-acute providers from home infusion to physical therapy typically depend on physician referrals for a significant percent of business. That’s not to say that referrals are always required. In physical therapy, for example, 32 states allow direct access within limits, but only 18 states allow unrestricted access. And we haven’t even touched on payer prior authorization requirements

You’re constantly jumping through referral and authorization hoops. The bottlenecks exhaust staff, frustrate patients and damage your bottom line. Not to mention, it creates real barriers to the care your patients need, inhibiting positive outcomes. Centralizing your patient intake and prior authorization processes can help reduce the staffing burden, smooth out your revenue cycle AND improve patient experiences. 

Getting started with centralized patient intake and prior authorizations

During a recent webinar with Ricky Overton, Director of Revenue at Results Physiotherapy, he shared his own experience of creating a centralized patient intake process. At the time, he led a revenue cycle transformation for a multi-state physical therapy provider with 224 clinics. 

Ricky prioritized staff education first. “In hospitality, I learned  if you cross-trained your staff, you had people to step in when others were out. It gave the staff confidence, let them see how it all operates, and made them feel more engaged,” he explains. With more training, staff members had improved awareness of how one role influenced the success of the next step in the process, leading to cleaner claims. 

Approaches to centralizing patient intake and prior authorizations can vary, but the overall workflow remains consistent. At a high level, this involves:

  1. Physicians write the order or referral.
  2. Patient intake verifies patient demographics and insurance.
  3. EMR data gets submitted to the centralized team.
  4. Reason for visit goes under review to verify it meets the benefits of service.

Eventually, the centralized team took on scheduling as well, moving all responsibility for gathering information away from the front desks of clinics. 

In addition to centralizing the process, Ricky established a prior auth triage role to troubleshoot denials, identify preventable issues and keep the intake team informed to reduce denials and rework. Ricky also leveraged technology, building an app to route incoming orders/referrals and batch verify them overnight.

Let’s take a closer look at the pros and cons of centralizing. 

The good: 

By centralizing the verification process, the staff at individual clinics had more time to focus on patients and improving engagement. Ricky says, “Often in physical therapy, we do the first treatment at the time of the initial evaluation. Waiting for prior authorization often leads to a delay in the next treatment, which makes it harder to keep patients committed to the therapy.” 

Ricky knows from experience that physical therapy can be transformative. The faster you can move patients from the physician’s referral to beginning therapy, the sooner they’ll start to see positive results. This solidifies your relationship with patients. In addition, for a referral based business, positive patient experiences help create champions for your practice. 

Staff experiences improve as well. By understanding the entire process, not just an individual piece of it, staff gained confidence. Removing unnecessary administrative tasks also led to higher job satisfaction, significantly reducing turnover. 

The bad: 

 “You can only throw so many people at a problem,” Ricky acknowledges. Despite the benefits realized by centralizing patient intake, you still have to staff the team. Back in 2018, the Medical Group Management Association (MGMA) reported that more than 60% of healthcare leaders were struggling to recruit non-clinical staff. Today, the challenge has grown. Between post-pandemic burnout, resignations and retirements, hiring competition is fierce. Prior authorization automation can relieve the strain, complementing centralized front- and back-office processes. 

The ugly:

Centralizing does not remove the prior authorization burden; it just brings it under a single umbrella of responsibility. Your staff still needs to stay up-to-date with payer rules and policies. With well-over 1,000 payers in the U.S., each with their own unique policies and prior authorization requirements, keeping up requires constant vigilance. Not knowing about a change can derail the claims process, impacting both your revenue cycle and your patients’ progress toward improved health. 

The Ultimate Solution: End-to-end prior authorization software

Myndshft offers prior authorization software that uses HL7 FHIR APIs, intelligent automation and Collective Healthcare Intelligence™to remove repetitive manual data entry from your patient intake process—whether it is centralized or not. You enter minimal information and the system takes over from there: 

  • Verifies real-time medical benefits for 94% of U.S. covered patients, including details on co-insurance, copay, deductible and other plan details.
  • Uses intelligent technology to search more than 2,000 payers and clearinghouse databases to identify active coverage and payer-specific benefits—even if secondary or tertiary coverage is undisclosed by the patient. 
  • Automatically calculates a patient’s financial responsibility, eliminating ‘surprise bills’ and improving the likelihood of being reimbursed. 
  • Determines prior authorization requirements, pre-screens the submission for errors and medical necessity, submitting it directly to the payer on the appropriate form via the payer’s preferred submission method. 
  • Maintains a single view of authorization statuses. 

The streamlined process across the entire workflow takes less than 5 minutes. Compare that to 45+ minutes per patient on a good day. If you spend time on the phone with payers (or annoying hold muzak), 45 minutes can easily morph into two or more hours. 

Want to see for yourself? Schedule a Myndshft demo today.