With the healthcare landscape making rapid shifts, organizations are looking for opportunities to increase revenue with existing capacity.

It is simple… more patients = more revenue, right?

But this is also true: more patients = more prior authorizations. And, when a prior authorization takes 30-60 minutes of clinical staff time to complete and weeks to get approved, you’re forced to either hire more FTEs, or schedule months in advance to accommodate the growing burden—both eating into potential revenue growth.

Indeed, while many providers may be booking procedures 2-3 months out, most clinics and hospitals also suffer from last-minute cancellations or reschedules. Whether it is a delay in prior authorization approval or a patient rescheduling for personal reasons, last-minute vacancies lead to:

  • Empty operating rooms
  • Idle scanners
  • Unused appointments

Vacancies are hard to fill on a moment’s notice, especially for procedures or tests that require prior authorization, and this adds up to hundreds of thousands of dollars in lost revenue for the average clinic and millions every year at hospitals. The problem isn’t the lack of patient demand to fill those vacancies; the problem is the turnaround time it takes to obtain prior authorization. Imagine how many vacancies could be filled if prior authorizations took minutes to complete and were approved 80% faster?

Case Study: Reducing Prior Authorization Bottlenecks Increases Monthly Revenue by 13-25%

At one regional medical center, their Pain Clinic and other procedural service lines were inundated with prior authorizations. The nursing staff was working overtime to get prior authorizations processed and approved. Patients desperate for pain relief grew frustrated with turnaround times and some left for other providers. Unable to obtain timely prior authorizations, the Pain Clinic was forced to turn patients away, leaving the provider’s schedules empty and revenue left on the table.

The hospital and its clinics turned to Verata Health’s artificial intelligence platform to automatically prepare prior authorizations and dramatically improve efficiency. Their nurses were entirely freed from working prior authorizations and turnaround times from payers decrease by 80%.

With the ability to now fill even last-minute appointments, the Pain Clinic dramatically increased procedural volume by 45% with their existing patient population in the year after launching Verata. (In fact, new patient consults were stable year over year, so we know that the procedural volume growth was due directly to removing the prior authorization bottleneck!)  As clinic productivity increased, revenue increased as well. A reduction in turnaround time meant consistently filled schedules resulting in an average annual revenue increase of 13-25% across every service line using Verata.

Clinical staff are happier. Administrators are happier. And most importantly, patients are happier.

How many of your procedures are canceled or rescheduled last minute, leaving your scanners idle and ORs empty? Imagine immediately filling those open appointments, reducing leakage, and growing revenues with your existing capacity. Solving your prior authorization bottleneck is key to unlocking your revenue growth potential.

To learn more about Verata Health, and how we are helping organizations increase revenue, contact us today.

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

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