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How Electronic Prior Authorization Can Reduce Denials and Improve Revenue Cycle Management

Prior authorization plays an essential role in revenue cycle management. It ensures patients get affordable care and medications. With the introduction of electronic prior authorization solutions, the process has become quicker, leading to a reduction in denials. Let’s understand in detail how electronic prior authorization solutions can reduce prior authorization rejections.

How Can Electronic Prior Authorization Reduce Denials?

Providers and patients often ask how to reduce authorization denials. After all, denied PA requests can restrict patients from getting the care they need to improve.

The simple answer is embracing electronic prior authorization. According to a study by the American Medical Association, practices using ePA experienced up to a 30% reduction in claim denials compared to those using traditional methods such as manual form filling and phone calls. But how can one reduce denials with the help of ePA? Let us find out how.

Verify Eligibility Accurately: The requirement for prior authorization for medications differs from payer to payer. This led patients to be clueless and wonder whether their medication needed prior authorization or not.

However, by electronic prior authorization, one can check a patient’s eligibility as per their payer requirements. It involves verifying whether the patient qualifies for the service according to their insurance plan.

It also allows providers to maintain accurate and updated patient information for prior authorization, helping patients and providers avoid PA denials due to inaccurate or incomplete patient information.

Minimizes Human Error: Wherever humans are involved, errors can occur, and the process of filing claims is no exception. One significant reason for errors or omissions was the increase in the volume of prior authorizations needed. This increased pressure on already overworked staff and clinicians to close prior authorization applications quickly.

However, with electronic prescription prior authorization solutions, administrative errors in prior authorization are reduced as the staff need not add codes or any information themselves. Since only accurate information is provided in EPA requests, payers can quickly check the appropriateness of the request. Hence, the number of denied requests is lowered.

Quickens the PA Process: Electronic prior authorization for medications eliminates manual work. This quickens the entire prior authorization process, resulting in avoiding denials due to administrative mistakes or errors in application forms. It also creates robust efficiency in granting medical services to patients and improves overall revenue cycle management.

Provide Data-Driven Insights: According to a report by the Healthcare Information and Management Systems Society (HIMSS),advanced ePA often provides analytical capabilities that help providers gain deep insight into authorization trends and behavioral patterns of payers.

It helps providers make informed decisions, optimize and improve their authorization processes, and realize opportunities for driving operational efficiencies. This empowerment to make informed decisions can make them feel more in control and confident in their revenue cycle management strategies.

Faster Approval Time: The ePA system significantly cuts approval times by as much as 50%, from an average of 14 days to 7 days. This quickens up the entire prior authorization process, avoiding denials due to missed deadlines. Thus, patients spend less time waiting for treatments and for providers to deliver services, making the process more efficient and patient friendly.

Conclusion

Electronic prior authorization solutions have revolutionized the way prior authorization requests are made. They help accurately verify eligibility for claim approval, eliminate human errors, and quicken the PA process. Such solutions also provide helpful data-driven insights and reduce the approval time for PA requests. All this leads to improved revenue cycle management.