When it comes to the healthcare industry today, few issues are as prominent as accessibility, and staffing. Representing two very different sides of the spectrum, they both require unique attention. Healthcare workers today are more overworked than ever, with hospitals being ever understaffed. Even worse, the pandemic highlighted and heightened this issue, with its effects being felt today.
Meanwhile, accessibility of care on the patient side is increasingly problematic. Millions of Americans lack insurance, with even more lacking coverage for essential services. Even for those with insurance, getting to and from the hospital is another complex issue which needs addressing. This is all to say that accessibility, alongside staffing, are deep-rooted and complex issues in healthcare today.
Fortunately, there is one solution that addresses, at least partially, both of these issues at once. Prior authorization is a process which inconveniences both patient and employee. Put simply, prior authorization is the process of a healthcare provider getting approval for insurance to cover a service. Today, up to 70% of these requests are done manually. The problem with this is that this is a steep administrative burden for workers today.
Manually submitting a prior authorization request is cumbersome. The healthcare provider has to review guidelines, patient files, contact the insurance company, submit the request and update files. It’s so cumbersome, in fact, that 35% of providers hire staff to explicitly deal with the process.
While this saves the provider much needed time, it also costs money. Money which many hospitals and treatment facilities simply do not have. So for many providers, they simply have to suck it up and spend the time to submit these requests. This not only delays care for the patient, reducing accessibility and availability of care, but adds to the provider’s burden.
Even worse, it’s becoming more and more common that prior authorization requests are simply denied. There is a clear process to appeal this denial, but it takes even more time. What this means, in many cases, is that care is simply not given, or has to be paid for out of pocket.
These reasons, and many more, are why prior authorization process automation is vital. It not only makes providers’ lives easier and saves money, but in some cases can literally save lives. Automated services can conduct the whole prior authorization process from top to bottom. They can gather files, look at requirements, contact the insurance company, submit the request, and most importantly submit appeals.
Of course, there are times when the automated system will kick out complex requests to humans. Yet the point remains, this is a significant improvement over manual entry. Most physicians today can’t pursue appeals or afford to take the time to submit a request. Even if automation helps with 10% of cases, this would be a massive improvement. Yet as much as 82% of the process can be automated under current AI-powered systems.
The difference this makes is staggering. It can not only save hundreds of millions, but will also save countless hours. It’s not a solution which addresses accessibility of care or understaffing directly, but it helps both. More importantly, it’s a change which costs very little to providers. People don’t pursue healthcare to submit insurance requests, they pursue healthcare to help. Automated prior authorization just makes their ability to do so much more realistic.
Source: Orbit Healthcare