Think about the ways in which technology has improved and modernized your revenue cycle operations:
- Registration staff verify insurance coverage and benefits electronically
- Simple visits are coded automatically
- Physicians order and charge electronically
- Edits are checked real time and driven to appropriate staff to work.
Now imagine your authorization and pre-certification operations, and you’ll see a very different picture:
You likely have clerical staff, pharmacy techs, and nurses who spend all day on the phone and payor websites gathering authorization, physicians getting involved to justify their orders, and dissatisfied patients who aren’t provided services in a timely manner. The amount of time spent interacting with payors can be a huge administrative burden, costing over $50,000 per physician every year in labor and lost productivity and putting .5% of net revenue from hospital charges at risk due to denials for authorization and pre-certification issues.
Why haven’t we modernized the operations and implemented any automation?
The short answer is technology hasn’t caught up, and it can be challenging to shift to more standard and centralized operating models. The good news is there are real steps you can take, and technologies you can now implement, to drastically reduce administrative cost and risk.
The Wilshire Groupis here to help you navigate those operational and technological changes.
Here are some of the opportunities to explore:
- Leverage the technology and operations you have
- Standardize and Centralize – You have likely centralized or standardized other pieces of your revenue cycle operations. Standardize workflow and reporting everywhere and take a critical look at your current operations and consider centralizing where appropriate.
- Assess Your Workflow and Workqueue Structure – A streamlined workflow and workqueue structure has staff working on the right authorizations consistently and automating handoffs with other staff. If they aren’t changes to your workqueue structure can help.
- Reporting and Dashboards– Create standard KPIs for your authorization operations, build reports to get those KPIs to the right managers, and train those managers on how to identify opportunities for continuous improvement and optimization opportunities.
- Implement new technologies with high ROI
- Real Time Authorization–Implement technology that allows you to obtain authorization for services with less human interaction. While this technology relatively new and has some limitations, it can significantly reduce your administrative costs.
The Wilshire Group has unique experience with implementing referral coordination models. If you are struggling with any of the above or want to talk about referrals or an authorization please reach out to Matt Perron and Freeman Jenkins.