akasa
AKASA
May 17, 2023

The Gist

Prior authorization is tedious, time-consuming, and costly — to the tune of nearly $11 per transaction. With a holistic prior authorization solution that addresses prior auth requirements, initiation, and status checks, however, your health system can resolve more requests in a shorter amount of time, free up your staff to work on more valuable tasks, and drive revenue for your organization.

Prior authorization is a vital function of the healthcare revenue cycle. Although it’s seemingly simple and straightforward, in reality, prior auth takes a lot of time and has multiple touch points, which often result in care delays, denials, and increased costs.

Hospitals and health systems that adopt a holistic prior authorization solution, however, stand to save a significant amount of time and money, improve care and the patient experience, and free up their staff to focus on more valuable tasks.

When AI and machine learning are leveraged in an automation solution, prior authorization tasks can be managed more effectively and holistically.

 

~ Amy Raymond, VP of Revenue Cycle Operations at AKASA

How Much Is Prior Authorization Costing You?

Although prior authorization is a relatively straightforward daily occurrence, it’s still one of the most time-consuming and costly functions of the healthcare revenue cycle.

The time and resources that revenue cycle staff unnecessarily waste on prior authorization could be spent on more valuable tasks, patient care, and efforts to improve the patient financial experience.

 

~ Amy Raymond, VP of Revenue Cycle Operations at AKASA

As time-consuming as prior auth is, it’s also critical to patient care. When prior authorizations aren’t accurate or complete, delays and denials can occur.

A report from the Department of Health and Human Services Office of Inspector General (OIG) found that of prior authorization requests that Medicare Advantage Organizations denied, 13% met Medicare coverage rules — services that would have been covered by Original Medicare — and were, in part, due to human error.

Fortunately, automation can help.

The Benefits of Authorization Management

Prior auth may feel like nothing more than a nuisance in the grand scheme of things, but it quickly adds up. Effective prior auth automation has the potential to save an average of 16 minutes per prior auth request — $437 million annually.

But true, holistic prior authorization automation brings a number of additional benefits:

  • Reduces staff burden and frustration, freeing them from tedious prior authorization tasks to focus on patient-facing activities.
  • Ensures all clinical and benefits information is initially submitted, decreasing delays, denied requests, and multiple payer follow-ups.
  • Reduces claim denials due to missing prior authorizations and drives reimbursement.
  • Minimizes reimbursement issues with timely notice of admissions (NOA).
  • Prevents care delays and improves patient satisfaction with a faster prior authorization process.

Looking for a true, holistic prior auth automation solution?

Meet AKASA Authorization Management

AKASA Authorization Management uses leading-edge AI and machine learning, backed by a dedicated team of RCM specialists, to navigate complex authorization processes and ever-changing payer portals and rules.

The AI power Authorization Management continuously learns from the responses and results of submitted prior authorizations, getting faster each time. If there’s an edge case it hasn’t encountered, it flags our RCM experts to handle the case and train the AI on new complexities, ensuring tasks get done on time, all the time.

Authorization Management works alongside existing workflows and applications, meaning there’s no disruption to current workflows. This holistic solution is capable of fully automating prior authorization for all providers — from physician groups to multi-billion dollar health systems, regardless of the EHR platform.

Payer changes around preauthorization requirements and increased demand to schedule diagnostic procedures as soon as possible is driving significant volumes for financial clearance. Hiring to handle these volumes can be challenging and isn’t always the most strategic solution. Machine-learning-based technologies, such as AKASA, have been critical to ensuring our teams can provide rapid turnaround for verifying eligibility and covered benefits, and securing an authorization.

 

~ Cynde McCall, Director of Patient Access and Health Information at Methodist Health System

Our suite of prior auth products includes:

  • Authorization Determination & Initiation
    We determine if prior auth is required and then submit a request along with any supplemental diagnosis and procedure codes and required medical records. Our process ensures that prior auth requests are thorough and accurate, which improves turnaround time.
  • Auth Status Check
    We obtain well-timed auth statuses and return detailed information to drive follow-up workflows. This eases staff burden and frustrations from tedious status checks.

To learn more about how AKASA Authorization Management can improve your prior authorization process, schedule a demo today.

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