We all know the importance of Prior Authorization (PA) and how it plays a direct role on the provider’s collections. The American Medical Association defines PA as, “Prior Authorization is the process by which physicians and other healthcare providers must obtain advance approval from a health insurance plan before a specific procedure, service, device, supply or medication is delivered to the patient in order to qualify for coverage.” A survey suggests that providers spend an average of 20 hours a week on the prior authorization process. No wonder providers lose revenue on missing or invalid auth.
Before moving on to the impact, let us first understand why payers demand to go through the Prior Authorization process for various services provided by physicians.
In a way, the Prior Authorization process is to keep a check on the quality of care provided by Physicians and to make sure the care is necessary, safe, accessible, and cost-effective. An important point to be noted here is that healthcare providers need not follow the prior authorization process in the case of emergencies. In some cases, the provider will go through the Prior authorization process post care which is also called retro-authorization.
Let us see some need-to-know facts about Prior authorization from a survey conducted by the American Medical Association.
These facts simply state the fact that Prior Authorization has a direct impact on both the quality of care and the physicians’ s revenue. An ineffective Prior Authorization process affects a practice’s RCM in the following ways
Quintessence understands how tedious the Prior Authorization process can be for providers. This process is something that needs high priority but at the same time, a very high time-consuming process that is not affordable by providers.
QuintAna by Quintessence is a series of BOTs that has been automating different scopes of the Revenue Cycle Management including the Prior Authorization process. QuintAna is custom-built for different practices to suit their respective needs. The BOTs can be programmed to identify services and procedures (through edits) that require Prior Authorization and can automatically go into the payer website and fetch the PA number for the patient. If PA is not available, the BOT automatically pushes such claims to the calling team.
With the help of QuintAna, practices can reduce the time spent on the Prior Authorization process by up to 65%. The BOT works independently from your PMS hereby we can immediately deploy the BOT and have it up and running in no time! Getting the best for RCM is now made possible with QuintAna by Quintessence.