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Myndshft Blog

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November 28, 2023

Unlocking Revenue Potential: The Power of Automated Prior Authorization in Revenue Cycle Management

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

The revenue cycle is the financial heartbeat of any healthcare organization. It encompasses both administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. At the core of this complex cycle is prior authorization—traditionally a time-consuming and often frustrating process. Automated prior authorization technology represents an opportunity to unlock new revenue potential.  Keep reading to see how automation revolutionizes revenue cycle management (RCM) by streamlining prior authorizations and reducing preventable errors that lead to revenue cycle-busting delays and denials.

The bottlenecks in traditional prior authorizations

Traditionally, prior authorization has created RCM gridlock due to:

  • Lack of consistency in requirements from payer to payer (and no single source of truth) that often leads to time-consuming scavenger hunts for payer policies just to determine if prior auth is required
  • Repetitive data entry that increases the likelihood of errors or omissions
  • Growing volume of medical and pharma prior authorizations, increasing the pressure on overworked staff and clinicians which contributes to burnout

Not only does prior authorization contribute to administrative overload, tying up resources that could be used more effectively elsewhere, but it throws a wrench in the revenue cycle and patients’ healthcare journeys. Delays and denials create barriers to care, which can lead to treatment abandonment, which directly impacts patient satisfaction and health outcomes. And that contributes to a declining bottom line too. 

How automated prior authorization helps

Automated prior authorization solutions use technology to remove the friction from the prior authorization process. It starts with collective healthcare intelligence—a single source of truth for patients’ health and benefits information, providers’ clinical documentation, and payers’ plans and policies. Using AI and machine learning, the software quickly navigates payer rules, reducing preventable errors and right-sizing the submissions. It then submits authorization requests directly to payers via their preferred method. By sending exactly what the payer needs—no more, no less—you avoid the back-and-forth phone calls or faxes (and annoying hold music), enabling faster payer reviews. Plus, you have visibility into next steps or approvals in one convenient dashboard, instead of rechecking multiple payer portals or getting on the phone (AGAIN) to verify status. 

In turn, this enhances revenue cycle  efficiency in multiple ways: 

Streamlined Operations: 

Automated prior authorization tools integrate with EHRs and practice management systems to facilitate a seamless flow of information. This integration helps in:

  • Reducing manual data entry and the associated human errors
  • Accelerating the authorization process, thus speeding up the overall revenue cycle
  • Allowing staff to focus on more rewarding, patient-focused tasks

Reduced Denials and Improved Cash Flow:

By securing required prior authorizations at the point of care, automated systems significantly reduce denials. This is particularly important when the service being rendered comes via a referral such as diagnostic tests. Because the software facilitates seamless data exchange, the servicing provider has relevant information from the ordering provider, allowing for timely submission.  This improvement leads to:

  • An increase in the number of claims approved on the first submission
  • A decrease in the time and resources spent on reworking denied claims due to missing information
  • Improved cash flow as a result of fewer delayed payments

Data-Driven Insights:

Automation provides a wealth of data that can be analyzed to gain insights into the authorization process, which can:

  • Identify trends in payer behavior to better predict future authorization outcomes
  • Highlight inefficiencies in the authorization process for continuous improvement
  • Allow management to make data-informed decisions to further optimize the revenue cycle

Enhancing Patient Satisfaction and Retention:

The benefits of automated prior authorization extend beyond the balance sheet to impact patient satisfaction:

  • Patients experience fewer delays in receiving care, improving their overall healthcare experience
  • Transparent communication about authorization status and coverage builds trust and loyalty
  • Reducing administrative tasks allows providers to focus more on patient care, improving clinical outcomes

Staying ahead of the curve with prior authorization software

In a healthcare landscape where policies and payer requirements are constantly changing, automated prior authorization can help providers stay compliant and up to date. The Myndshft prior authorization platform, for example, is built to meet future standards for interoperability and industry best practices for security. Automated prior authorization represents a transformative force in revenue cycle management, turning a cumbersome process into a strategic advantage. By embracing this technology, you can unlock new revenue potential, streamline your operations, and significantly enhance patient satisfaction. In an industry where margins are thin and patient expectations are high, automated prior authorization can help your revenue cycle move from survival mode to success.

The power of automation in prior authorization is clear: it’s a catalyst for efficiency, a builder of patient trust, and a crucial tool for financial stability. As healthcare continues to march towards a more tech-driven future, automated prior authorization stands out as an example of how innovation can improve not just the bottom line, but the entire healthcare delivery system.

Want to see it in action? Connect with Myndshft to arrange a demo.