Sherif Barakat, Customer Success Manager

For physicians, practice managers, and staff – hearing the term ‘prior authorization’ can send shivers down their spines. If we were to look up the term prior authorization in a dictionary, ‘burden’ would be right next to it. Prior authorizations have been around for decades, but not much has been done to reduce the burden on practices. In a survey conducted by the Medical Group Management Association (MGMA) in 2019, 90% of respondents said they saw an increase in prior authorization requests over the last year. It’s no surprise that those same respondents noted that prior authorizations are a “drain on clinical resources.”

As a Customer Success Manager at Verata Health, I work closely with private practices and large health systems across the country to streamline their prior authorization process and my customers achieve faster prior authorizations. Much of that work involves documenting current processes and deploying best practices within a practices’ current workflow to improve the prior authorization process.

Five ways to achieve faster prior authorization turnaround times

Utilize online payer submission portals

  • In the past few years, more and more payers have been rolling out online prior authorization submission portals. A practice can speed up the process of obtaining a prior authorization in as little as 24-72 hours using an online portal. Online portals give practices the ability to continuously check on the status of the submission, which reduces the time spent on hold with a payer and can reduce the total number of calls a staff member has to even make to the payer.

Fully utilize your EMR

  • Electronic medical records (EMR) have transformed clinical documentation and patient interactions, though very few practices effectively utilize the tools within their EMR to automate their workflow. Surprisingly, a significant number of practices continue to print out and file away patient charts, even with an EMR. Having both physicians and staff effectively utilizing the tools in their EMR, like order creation and clinical documentation, can significantly decrease submission disruption and lead to faster prior authorizations.

Minimize peer-to-peer reviews

  • Making sure that your staff is well versed in the various payer requirements before submitting a prior authorization is essential; otherwise, peer-to-peer reviews can happen. A prior authorization that typically takes two business days now takes ten business days to approve because a peer-to-peer review is needed. By ensuring your staff understands the payer requirements, you can minimize peer-to-peer reviews and speed up approval times.

Improve your workflow

  • Reducing bottlenecks in your workflow is key to streamlining the prior authorization submission process. Bottlenecks may include manual processes, such as sorting through faxes, printing, and scanning paperwork. Utilizing payer portals, researching payer requirements ahead of time, and completing encounter notes within 48-hours are all improvements that can be made to reduce bottlenecks in the prior authorization process and completes prior authorizations fast.

Leverage Artificial Intelligence

  • Don’t be afraid of change. Start utilizing prior authorization AI. Leveraging technology can remove all the unnecessary manual work when submitting a prior authorization. The days of printouts, filing, faxes, and spreadsheet tracking are a thing of the past. Take Pro Sports Orthopedics, for example—an 11-person orthopedic surgical team out of Boston, Massachusetts. The practice faced many challenges because of bottlenecks in their workflow, which caused delays in turnaround times. After implementing Verata’s Frictionless Prior Authorization® artificial intelligence platform, Pro Sports immediately saw faster turnaround times and has eliminated the need for any paperwork. Additionally, their team of surgical coordinators now have the flexibility to work from home with a new ability to log-in to Verata’s secure platform.

To learn more about Pro Sports prior authorization transformation with Verata Artificial Intelligence and how you can achieve faster prior authorizations, click here.

About Verata Health

Verata Health is the only prior authorization software solution that leverages powerful artificial intelligence to automate the prior authorization process from end-to-end. Verata helps practices standardize and scale the prior authorization process organization-wide. If reducing write-offs, increasing patient throughput, and freeing up valuable staff time is something your practice is looking to achieve, schedule a demo with Verata today.