Hospitals and providers are under tremendous pressure to reduce costs and maintain margins in a rapidly shifting health care landscape—now more than ever.

One of the most challenging and costly administrative challenges in health care is prior authorization. In fact, prior authorization accounts for over 30% of all preventable write-offs for hospitals and providers today. For the average practice, this is hundreds of thousands of dollars of preventable losses every year.

Write-offs due to prior authorizations are often due to three types of errors:

  1. Not submitting a prior authorization that is required,
  2. Delay in filing a prior authorization,
  3. CPT coding or other errors that do not match what you bill.

Each of these types of errors is preventable, but when juggling thousands of different insurance plans, a crush of surgery bookings, and complex coding, navigating prior authorization can feel like a field of landmines. Any single error could result is thousands of dollars in expensive write-offs months later.

Case Study: Solving Prior Authorization Reduces Write-Offs by 35%

New England Baptist Hospital (NEBH), a top orthopedic specialty hospital ranked by U.S. News & World Report with 90 affiliated surgeons, faced the same prior authorization challenges felt by orthopedic practices and surgery centers around the country. Prior authorizations were done manually by overworked staff, who kept binders of insurance rules and CPT codes with post-it notes peppered across their desks. Unintentional mistakes resulted in downstream write-offs that affected both provider and facility fees.

To address the expensive challenge of prior authorizations, NEBH and its affiliate orthopedic practices implemented Verata Health artificial intelligence to automate and standardize their prior authorization process. Verata Health is the only end-to-end prior authorization platform that automatically retrieves relevant clinical documentation directly from the EMR, grades clinical documents against payer medical necessity rules, prepares an authorization submission, and tracks the authorization to approval.

“Verata Health is one of the best decisions we’ve ever made.”

— Tom Gheringhelli, Chief Financial Officer of NEBH

Eliminating manual processes transformed NEBH operations in just a few months. The new solution gave schedulers at NEBH a single prior authorization platform that dramatically reduced the amount of time staff dedicated to preparing prior authorization submissions, increased prior authorization approvals, and reduced errors.

Most importantly, NEBH strengthened its financial position. In a year-over-year comparison, write-offs were reduced by 35%, and staff costs dropped 25% through increased productivity. Moving to an automated platform delivered a 4X return-on-investment in just the first year.

NEBH and their affiliate practices have recaptured lost revenue and improved their financial bottom-line, and you could too.

To learn more about Verata Health and how we prevent write-offs, contact us today.

Take the burden out of Prior Authorization. Start with Verata.

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