All Pre-Authorizations

What Makes Outsourcing the Best Method for Prior Authorizations?

Physicians didn’t go to med college to spend their lives administering or waiting for prior authorizations, yet it sometimes feels like this is all they’re doing these days.

According to a recent American Medical Association poll, 90% of responding doctors felt that the “administrative burden due to Prior Authorization (PA) requests has grown in the past 5 years, with the majority indicating it has ‘increased massively.'” As health services continue to shift toward value-based payment models, insurers may require more PAs in order to achieve more outstanding cost management.

The healthcare sector has responded to this perceived load with potential remedies ranging from technological expenditures such as automation to guidance documents from industry groups promising authorization process improvements.

However, optimizing industry-wide standards might take a couple of years, and since the authorization procedure can entail several, complicated phases along a wide range of medical treatments, solutions like in-house automation may perform badly to improve workflow efficiency.

As stated in the 2018 CAQH Report, a yearly report on the implementation of electronic financial transactions, 88 % of Prior Auths is filed manually. For medical institutions and practices looking for a more direct path to an improved PA programme, Business Process Outsourcing (BPO) is proven to be a cost-controlling and work-efficient alternative to manually-driven authorization control.

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More than just Lift-and-Shift

Companies frequently use BPO as a cost-efficient technique, lifting & shifting crucial functions to a low-budget, offshore provider. Cheaper expenses, on the other hand, aren’t vital as operational growth and effectiveness. Modern BPO providers apply strategic planning and cost-cutting innovations to complicated healthcare procedures, allowing providers to operate more successfully in a highly regulated and ever-changing market.

Rather than just attempting to reduce transactional expense, today’s modern BPO vendors assist medical organizations and practices in identifying methods to optimize processes which will have a long-term downstream impact on the practice. BPO vendors begin by assessing the company’s goals and needs before developing a solution to satisfy them. It could still be lift-and-shift in certain circumstances. In other circumstances, it could be preferable to remove a process altogether or to digitize all.

Why Do BPO Auths Work?

Effective automation requires both solid business procedure design and technology. There are other elements to consider, such as system usage, business effect, data connections, labour investment return and funding. It is extremely challenging to achieve efficient automation in the face of limited IT and operational expenditures. Another challenge is personnel, since authorization staff are prone to rapid turnover and, as stated below, locating individuals with the necessary expertise and skillsets.

An expert BPO provider will evaluate all possibilities to identify the best route to take. This may involve deleting or changing a process instead of merely using technology to render ineffective operations more effective. Knowing the objectives and then picking the appropriate method(s) to achieve them is at the heart of a successful BPO business partnership.

Picking a BPO Partner

BPO at a significant level necessitates a large investment in terms of money, as well as other resource capabilities, particularly at the outset of the relationship. The company will commit a portion of its firm to the BPO partners. Modern BPO engagements require greater cooperation and true business process management skills.

By conducting due diligence & asking vital questions beginning of the project, best practice providers position themselves for excellence. Some of these inquiries may include:

That however much foundation does the partner has in each of the services you provide?
What level of expertise does the partner hold in the fields in which you work?
How can a partner supply client referrals similar to yours?
What automated tools does the partner offer to continuously enhance monitoring and capabilities?
Could this partner provide proof of their capacity to climb?

Final Thoughts:

The ultimate objective is to create a relationship that provides you with the skills, best practices, and assets you require. The choice of a partner who understands the provider’s objective and who has a track history of effectively implementing that vision in conjunction with the client is the initial step in developing this lasting relationship.

These characteristics serve as the cornerstone of a solid BPO relationship that will aid healthcare organizations in overcoming the demands and difficulties they encounter during the Prior Auth process.

Outsourcing your prior authorization processes will assist you in increasing your profit margins, claims processing, and reimbursements. We specialize in next-generation RCM services like prior authorizations to assist medical practices in improving cash flow and streamlining their medical billing procedures. Please contact us at [email protected] to learn more about how we may assist you.