February 18, 2021
For physicians and healthcare staff, hearing the term “prior authorization” can send shivers down their spines. If we were to look up the term “prior authorization” in a dictionary, “burden” would be right next to it.
Prior authorizations have been around for decades, but not much has been done to reduce the burden on providers. In a survey conducted by the Medical Group Management Association (MGMA) in 2019, 90% of respondents said they saw an increase in prior authorization requests over the previous year. It’s no surprise that those same respondents noted that prior authorizations are a “drain on clinical resources.”
As a customer success manager at Olive, I work closely with hospitals and large health systems across the country to streamline their prior authorization process, and my customers achieve dramatically faster prior authorizations as a result. Much of that work involves documenting current processes and deploying best practices within the current workflow to improve the prior authorization process.
Five ways to achieve faster prior authorization turnaround times:
1. Utilize online payer submission portals.
More and more payers have been rolling out online prior authorization submission portals, which can speed up the process of obtaining a prior authorization to as little as 24–72 hours. Online portals give practices the ability to continuously check on the status of the submission, which reduces the time spent on hold with a payer and can reduce the total number of calls a staff member has to make to the payer.
2. Fully utilize your EHR.
Electronic health records (EHR) have transformed clinical documentation and patient interactions, though very few providers effectively utilize the tools within their EHR to automate their workflow. Surprisingly, a significant number of providers continue to print out and file away patient charts, even with an EHR. Having both physicians and staff effectively utilizing the tools in their EHR, like order creation and clinical documentation, can significantly decrease submission disruption and lead to faster prior authorizations.
3. Minimize peer-to-peer reviews.
It is essential to ensure that your staff is well versed in the various payer requirements before submitting a prior authorization. Otherwise, peer-to-peer reviews can happen. A prior authorization that typically takes two business days now takes 10 business days to approve because a peer-to-peer review is needed. By ensuring your staff understands the payer requirements, you can minimize peer-to-peer reviews and speed up approval times.
4. Improve your workflow.
Reducing bottlenecks in your workflow is key to streamlining the prior authorization submission process. Utilizing payer portals, researching payer requirements ahead of time, and completing encounter notes within 48 hours are all improvements that can be made to reduce bottlenecks in the prior authorization process and complete prior authorizations fast.
5. Leverage artificial intelligence
Don’t be afraid of change. Start employing prior authorization AI and take advantage of the technology that can remove all of the unnecessary manual work around submitting a prior authorization. Learn more about how Olive’s AI end-to-end solution can help you achieve faster prior authorizations and maximize your health system’s ability to deliver faster, better care.
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