Hospitals and health care providers are in the business of saving lives, but like all businesses, they can’t accomplish their mission unless they have processes and policies in place to remain financially healthy

 

Prior authorization’s impact on revenue cycle management

Revenue cycle management (RCM) needs to operate efficiently and generate enough revenue to keep the organization healthy.

Prior authorization is essential in RCM. If a medical procedure does not receive approval from the payer before treatment occurs, the patient or the hospital can be stuck with a massive, unexpected bill, causing financial strain for the entire organization.

Historically, manual tasks have slowed down prior authorizations, leaving patients with long wait times, a process more prone to human error, and money on the table when patients are unable to receive care.

All of these consequences leave RCM vulnerable.

Administrative prior authorization processes are estimated to add as much as $25 billion to the cost of healthcare in the United States, according to the Council for Affordable Quality Healthcare. The American Hospital Association estimates that hospitals will lose an additional $323 billion this year due to the COVID-19 pandemic.

With all of the challenges created by COVID-19 on top of already astronomical administrative costs, never has there been a more critical time for revenue cycle leaders to increase cash flows.

Executives must identify new strategies to insulate and future-proof their business operations. One-way RCM leaders have done this is through automation and AI-powered prior authorizations.

How AI can transform RCM

Verata Health offers the first and only solution for prior authorization that RCM leaders can use to solve the biggest challenges they face: saving money, reducing write-offs, and increasing revenue.

Here are three ways AI prior authorizations can supercharge your revenue cycle:

Improve operational efficiency

A single prior authorization can take 30-60 minutes to complete manually. With an average of 30 prior authorizations per physician per week, that adds up to nearly two days per week of staff time.

A fully automated prior authorization solution drastically reduces the administrative burden that too often falls on already overworked nurses or clerical staff, resulting in faster turnaround times and increased productivity across the entire organization.

It creates a standardized, streamlined workflow to increase the efficiency of prior authorization staff and reduces time-consuming follow-ups with payers.

Reduce write-offs and denials

Prior authorizations account for 30% of all health system write-offs, resulting in millions of dollars in preventable write-offs every year. With staff forced to navigate hundreds of health plans and rules across dozens of portals, human error resulting in thousands of dollars in write-offs is inevitable. Indeed, prior authorization is one of the most common causes of preventable write-offs for hospitals and health systems.

Artificial intelligence takes human error out of the equation by managing tens of thousands of complex insurance rules, learning from prior authorization decisions, and automating the authorization workflow.

An AI-powered solution decreases by 80% the amount of time it takes to submit a prior authorization, reducing delays and abandonment, lowering staff burden and overhead costs, and preventing costly write-offs.

Increase revenue

Prior authorization delays lead to empty operating rooms, idle scanners, and unfilled schedules—in other words: lost revenue.

AI reduces patient leakage and maximizes capacity—single-handedly boosting an organization’s bottom line. Verata Health’s AI-powered prior authorization RCM solution has been proven to increase revenue by 16%.

Time is also money. With an AI solution, time spent during prior authorization can shrink from more than two weeks to 24-48 hours, meaning hospitals can fill last-minute cancellations or openings and optimize their capacity. Patients get more timely care, and providers know upfront that costs are covered. Everyone wins.

It’s time to supercharge your RCM

Providers need a partner who fully understands end-to-end healthcare revenue cycle processes and offers an integrated, rather than siloed, approach. Verata’s AI-powered prior authorization software solves all of your prior authorization and RCM challenges, and it’s the only prior authorization solution proven to increase revenue.

Verata Health has helped hospitals and practices achieve:

  • 78% reduction in turnaround time
  • 25% increase in patient bookings
  • 16% increase in billing/revenue
  • 32% reduction in write-offs

To learn more about Verata Health and how we can help you gain a competitive edge, contact us today.

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

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