Sherif Barakat, Customer Success Manager

Whether it’s the constant change in clinical requirements, the high number of peer-to-peer reviews, or the costly delays in care, we have all experienced the toll it takes on all parties involved when obtaining prior authorization. And no, they’re not going away anytime soon.

According to the 2018 AMA survey, 88% of participants said the burden of prior authorizations has gone up in the last five years. Paper, fax machines, and post-it notes have been the way of life for many private practices and hospital systems in processing prior authorizations. As a Customer Success Manager at Verata, I work closely with private practices and large health systems nationwide to streamline their prior authorization process. Luckily, there are areas where you can make improvements and help you achieve greater success when completing prior authorizations.

Areas for Improvement

Workflow Optimization

  • It’s always good practice to review your current prior authorization workflow every six months. New staff hires, or turnover can often alter the design of your workflow, so reviewing your process regularly keeps things organized amidst any staff changes. Manual workflow processes have led practice staff to spend approximately 30-45 minutes on a single prior authorization submission. The current submission process includes researching payer requirements, pulling together the necessary clinical documentation, completing the payer form, and manually faxing over the submission package. Leveraging artificial intelligence can drastically reduce much of the manual submission process, leading to faster turnaround times and an increase in staff productivity.

Clinical Documentation

  • The #1 reason why peer-to-peer reviews occur is due to the lack of clinical documentation. According to a Health Affairs survey, practices spent an annual average of $68,274 per physician in time spent interacting with health plans. Whether due to delayed clinical notes or inconsistent clinical documentation, peer-to-peers will be an unfortunate and frustrating result. Establishing clear protocols from the onset will provide physicians and staff with the clarity needed to minimize peer-to-peers. It’s always best practice to have previous encounter notes made readily available in the EHR within 24-hours. Physicians should document conservative treatments and comorbidities in meeting medical necessity criteria and, practice staff submitting a prior authorization request should have a clear understanding of the payer requirements. Though some peer-to-peers are inevitable – following these tips will significantly reduce the disruption to your practice workflow in delivering excellent patient care.

Reporting

  • Practice Managers are pulled in many directions throughout the workday, and reporting may be the last thing on their minds. Often, practices have resorted to tracking prior authorizations with large excel data sets, folders, and print outs. Manual tracking and reporting come with inconsistencies and take a significant amount of staff time to maintain. The lack of reporting and visibility can be costly – according to the Medical Group Management Association (MGMA), the average denial rate for most medical practices ranges from 5% to 10%. When we’re talking about millions of dollars in claims, 5-10% in denials adds up quickly. Course correction is possible with Verata’s in-depth reporting capabilities. For instance, by using Verata’s software to pull data on how many peer-to-peers a physician experiences, managers can help reeducate providers on specific payer requirements and other barriers they are facing. Utilizing artificial intelligence is a great way to understand your practice’s pain points quickly and efficiently with reporting tools that provide real-time data and visibility into all prior authorizations.

Premier Orthopedic Practice Streamlines Prior Authorizations with Verata

Longwood Orthopedic Associates (LOA), based out of Boston, Massachusetts, is an excellent example of a practice that faced the many challenges of manual prior authorizations. The lack of ability to track prior authorizations caused physicians to schedule their patients at least 30 days out to factor in the average prior authorization turnaround time. Physicians were spending more time on peer-to-peer calls, and medical assistants were spending hours on hold with payers—taking up valuable patient care time. After implementing Verata’s Frictionless Prior Authorization® platform, LOA immediately saw faster turnaround times, an 80% reduction in peer-to-peer calls, reduced FTE spend by 50%, and has been able to schedule their patients sooner rather than later.

To learn more about Longwood Orthopedic Associates’ prior authorization transformation using Verata Artificial Intelligence, 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 across the organization. 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.