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Myndshft Blog

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April 11, 2023

How Does Prior Authorization Software Support Growth for Ambulatory Surgical Centers?

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

The Ambulatory Surgical Centers (ASC) market has been witnessing steady growth in recent years. Back in 2010, 48% of outpatient surgical procedures took place in ASCs. By 2019, that figure rose to 60%. Then the pandemic hit, further accelerating growth of ASCs. More traffic, however, likely means more prior authorizations so ASCs need to consider how to efficiently manage growing administrative demands that will otherwise shrink their margins further. That’s where prior authorization software can help. 

Before diving into the benefits of prior authorization for ASCs, let’s take a closer look at the trends behind the expanding popularity of ASCs. 

4 factors contributing to ASC growth

According to a McKinsey article, convenience and more personalized experiences attract patients, but the biggest attraction is cost savings. “Perhaps most persuasively,” write co-authors Dr. Pooja Kumar and Ramya Parthasarathy, “costs to both patients and payers can be significantly less at ASCs, as their entire operating chassis is often configured at a lower cost base across staffing, space, and some types of supplies, while margins for healthcare providers can often be the same or higher.”  

1. Increased cost-consciousness among patients 

Healthcare consumerism has been gaining momentum in lockstep with the rise of narrow networks and high-deductible health plans. With more skin in the game, patients want quality care that doesn’t break the bank. Often, ASCs fit the bill. In fact, the McKinsey article notes, “Though the out-of-pocket savings opportunity varies by plan and procedure, studies have shown consistently lower costs at ambulatory sites—providing strong incentives for patients to shift their site of care.” 


2. More payer pressure to shift to less costly care sites

Those lower costs that attract patients’ attention also attract payers. Often, they use prior authorization to shift care to ASC settings over more costly, hospital-based procedures. Take cardiovascular procedures. Cardiovascular Business notes that the Centers for Medicare and Medicaid Services (CMS) has been “… culling the inpatient-only procedure list to allow more outpatient procedures. The shift of such cases from the hospital to a lower-cost site of care are only going to continue.” 

3. Technological advancements enable efficient, minimally-invasive surgeries

Advancement in medicine and technologies has transformed many procedures that used to require a hospital setting. Offering shorter recovery times and lower risk of complications, minimally invasive procedures are a good fit for ASCs. Consider the specialties that dominate in ASCs now: orthopedics, gastroenterology, ophthalmology, urology. All have benefited from advancements like robotic-assisted surgery, laser surgery, and more. And as mentioned in #2, it appears that technological advances make it possible for a growing number of cardiovascular procedures to shift away from in-patient to out-patient or ASC settings. 

4. Heightened demand from an aging population

In a few short years, every Baby Boomer will be 65 or older—all 74 million of them. Let’s face it: the number of people needing cataract surgeries, knee and hip replacements, diagnostic heart catheterizations and other common procedures will skyrocket. All of these procedures are being done at ASCs today, so it’s likely that the volume of care being delivered by ASCs will expand in response. 

How can prior authorization software benefit ASCs? 

ASCs attract patients and payers by delivering high-quality, cost-effective care. However, that also means that ASCs have slimmer margins that demand efficient processes. Instead of settling for the status quo—a time-consuming, manual prior authorization process—ASCs can realize numerous advantages from fully-automated, end-to-end prior authorization. 

The manual prior authorization process increases opportunities for typographical errors or missing information. Myndshft prior authorization software requires very little data entry because it combines automation with Collective Healthcare Intelligence™, allowing seamless access to patients’ health and benefits information, providers’ clinical documentation, and payers’ plans and policies. 

Once you add minimal details, the software takes over. Instead of a time-consuming search through payer documentation in binders or on a portal to determine if a procedure or medication requires prior authorization, the software moves through the process in minutes.  

  • Verifies a patient’s benefits and eligibility.
  • Discovers if additional coverage exists (i.e., a secondary payer) for coordination of benefits.
  • Calculates a patient’s financial responsibility. 
  • Determines if prior authorization is required and what the submission criteria entails.
  • Prechecks the prior authorization request for errors or omissions.
  • Submits the prior authorization request to the payer via the payer’s preferred submission method.
  • Monitors the status of prior authorization requests in a single location. 

The results speak for themselves. A process that typically takes 15 to 30 minutes, not including time spent searching for information or waiting on hold for a payer, shrinks to less than 6 minutes. This frees your staff and clinicians to focus on patients, not paperwork, so you can grow your business. 

In addition to the time-savings, automation minimizes errors related to incorrect data entry or missed steps. Fewer preventable errors means less time spent reworking claims. This can lead to less revenue lost due to delays, treatment abandonment, or denials. 

A more streamlined, accurate process also directly impacts patients, leading to better outcomes and higher patient satisfaction.  

Are you ready to see how automated prior authorization can benefit your ASC?
Connect with us to arrange a demo.