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Myndshft Blog

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November 16, 2022

Prior Authorization Your Nemesis? Superhero Strategies for Vanquishing Delays & Denials

by Susan Lawson-Dawson | Prior Authorization, Revenue Cycle Management

After months of media buzz, one of the most anticipated superhero movies of 2022 hit theaters over the weekend—and by all accounts delivered a heroic performance at the box office. It got us thinking. How can healthcare providers apply superhero traits to beat prior authorization challenges? 

Staffing & Financial Impact of Delays & Denials 

In a November report and infographic, the American Hospital Association states, “Inappropriate prior authorization and payment denials result in significant disruption for hospitals and health systems, challenging their ability to continue caring for their communities.” The survey of 772 hospitals and health systems reveals the burdens posed by delays and denials.

On the staffing side, 95% say that the prior authorization approval process requires an increasing amount of staff time. One reason? The need to rework denials, which is even more frustrating because 62% of appealed prior authorization denials are reversed. That’s time that could have been spent on patient care, rather than paperwork. 

The delays and denials have a financial fallout too. According to the AHA survey, 50% of respondents have $100 million in accounts receivable for claims that are older than six months. In addition, 35% report losing $50 million or more due to denials. How far back do these delayed or unpaid claims go? 

7 in 10 have outstanding claims from 2016 or before

You may not be able to leap over prior authorization delays and denials in a single bound but thinking like a superhero can help. 

Be proactive

We tend to think of superheroes as reactive: Swooping in to save a world (or person) in peril. But there are proactive superheroes too.  While you may not be a doctor with time-bending abilities, you can become more proactive with prior authorization triage. It’s a process of reviewing denials to identify common causes. Perhaps it’s a trend with a certain payer. Maybe it’s a hiccup in the patient intake process. Whatever the cause, the triage process surfaces fixable issues to reduce the likelihood of future denials. 

Don’t fly solo

Even though movie superheroes can work alone, they often make the greatest impact when they work as a team. One reason the triage role works is because that person shares the insights gained from analyzing denials. Breaking down the walls between front office, clinical, and back office staff—through frequent communication and training—creates a team that understands how individual contributions combine to eliminate preventable denials and speed patients’ access to care. 

Embrace innovative technology

Technology plays a big role in superhero status. Retractable power suits. Levitating vehicles. The list goes on. Prior authorization software takes advantage of technology so you can accelerate the process. Instead of repetitive data entry, you enter minimal data and then intelligent automation takes over, pulling and pushing data from patients, providers and payers to: 

  • Identify if prior authorization is required and what the submission criteria includes
  • Automatically select the appropriate submission form and populate the form with the needed data, including clinical encounter details, directly from an EHR or other system of record
  • Pre-screens for errors and medical necessity, reducing up to 90% of claims rework
  • Submits direct to the payer using preferred submission method, fax, payer portal, or EDI 278 transaction
  • Monitors request status, with approvals returned directly to the system of record. 

Prior authorization software may not be as flashy as an arc reactor or strong as a Vibranium shield, but it does accelerate the process and reduce preventable errors so that you can rescue your revenue cycle and get patients the care they need, sooner. 

Ready to unlock your inner superhero? Find out why Myndshft prior authorization software is the key.