Penrod Blog

How to Automate Prior Authorization with Salesforce

Providing quality care while preventing no-authorization denials is no easy feat. Even worse, prior authorization isn't just your problem — patients are also caught in the crossfire. As payers tighten patient eligibility requirements, you may have experienced escalating obstacles to scheduling care, incurring substantial losses in revenues and operational costs.

We've noticed the rising trends among our healthcare provider clients; they've started automating prior authorization, resulting in quality, timely care and better patient outcomes. This article explores why automating prior authorization at your healthcare facility is vital.

Challenges of Manual Prior Authorization

The big irony is that most healthcare facilities still utilize manual prior authorization in today’s digital climate. This process burdens care providers, patients and insurance companies.

According to the American Medical Association, 34% of healthcare providers say that manual PA has caused severe effects on patient outcomes, including injuries, disabilities and hospitalization. Further, 93% of care providers cite delays with manual PAs, and 82% report abandoned care services.

Physicians claim to spend up to 14 hours weekly on PAs, straining their resources and increasing workload demands.

Payers’ policies change all the time, making the process even more hectic. It’s highly challenging for providers to ensure accuracy in submissions. With some procedures requiring approval under specific rules, don’t be surprised that many authorizations are denied, wreaking havoc on patients and care providers.

But automating your PAs can alleviate the pressure, enabling you to deliver efficient and quality car services.

The Benefits of Automating Prior Authorization

Quality care services should be the primary goal for any physician. But with the challenges associated with manual PAs, attaining this goal is no easy task.

With increased complexities in revenue cycles and extensive strain on limited resources, the shortcomings of manual PAs have become too apparent to healthcare providers. However, healthcare facilities that have embraced automation are already realizing its benefits.

Automating the PA process provides multiple advantages to patients, healthcare providers and payers, including:

  • Increased Efficiency
    Automating PAs cuts the cost of resources and effort required for manual processing, accelerating workflow and enhancing better outcomes. Automation eases the pressure on healthcare facilities, enabling more authorizations to be processed within a short time and making it easy for staff to track follow-up inquiries.
  • Cost Savings
    For many healthcare organizations, processing PAs requires intensive staffing for optimum efficiency. This translates to the increased financial burden on healthcare. However, with automation, most work is done electronically, reducing the need for heavy staffing, which translates to cost-saving for healthcare facilities. A faster approval process implies quality and timely service to more patients, reducing operational costs.
  • Better Patient Care
    Quicker authorization approvals not only reduce the risk of denied claims but also mean patients receive care without delays. When patients access necessary treatment, it improves satisfaction and overall health outcomes.
  • Seamless EHR Integration
    Automating PA systems offers an opportunity to integrate the process with your electronic health records (EHR) and other systems to provide streamlined services. This reduces the bottom-line delays and enhances efficiency while creating a reliable healthcare system.
  • Real-time Tracking
    Automating PAs allows you to track real-time authorization requests, enhancing reporting and effective care service.
  • Accelerated Revenue Cycle
    Automated authorization improves request approval, expedites billing, reduces time, and increases reimbursement rate. This allows providers to improve services and increase the number of patients served, affecting the revenue cycle positively.
  • Regulatory Compliance
    The Centers for Medicare & Medicaid Services created CMS-0057-F, or the Interoperability and Prior Authorization Rule, to govern efficient data exchange between care providers, patients and insurance companies. Automating prior authorization helps many covered payers comply with the rule’s requirements.
  • Automating prior authorization may not resolve all conflicting perspectives of cost-conscious patients and over-burdened healthcare facilities. However, it can significantly reduce administrative burden. Automating PA streamlines data exchange, enhancing communication among patients, providers and payers.

Best Practices for Automating Prior Authorization with Salesforce

To minimize financial, time and operational costs associated with manual PAs, providers can fast-track automation with technology platforms like Salesforce that reduce over reliance on human intervention – while streamlining administrative and operational activities.

The impact of automation is spurring increased adoption across different healthcare departments, including prior authorization. If you’re tired of overburdening your staff with manual processes and delayed patient care, it’s time to explore the Salesforce automation procedure.

With Utilization Management for Health Cloud, providers can:

  • Verify eligibility and benefits beforehand to alleviate possible administrative denials
  • Submit and track authorization requests electronically via electronic PA (ePA), eliminating the need for manual processing
  • Have real-time track of the submitted requests
  • Have insight into submitted PA requests, enhancing operations
  • Enhance integration between EHR and Health Cloud for creating PA requests
  • Your PA automation doesn’t have to be complicated. The following steps can help automate PA in your healthcare organization.

Step 1: Demographic Audit

It’s essential to automate quality assurance measures to audit patients’ information before submitting PA. An integrated initial step of the PA achieves the following:

  • Automatically audits complete patient registrations to point out and prevent administrative and financial hurdles.
  • Utilize pattern recognition to continuously update automated tools to eliminate recurring errors.
  • Alert staff of errors in payment along with mitigating procedures.

Step 2: Verify Patient Benefits

Real-time verification for patient eligibility analyzes data, eliminating issues that may cause denial of payment through:

  • Delivering general and targeted service verification
  • Automating manual real-time submission
  • Verifying self-pay patients
  • Providing benefit threshold alerting

Step 3: Determination

Arguably, the most time-consuming process in PA manual processing is determining when an account needs authorization. Automating determination limits time spent on fax machines or phones communicating with payers to determine authorization for services required.

Step 4: Retrieval

The last step included automating retrieval to alleviate the need for manual verification on payer portals. Salesforce automation tools can help you monitor response status and retrieve authorization, plus additional information requests.

Automate Prior Authorization with Salesforce

Relying on manual prior authorization can have adverse impacts on your healthcare facility. We’re committed to serving companies and their patients authentically and creating solutions that improve outcomes.

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Let's talk about how we can automate prior authorizations with Salesforce.

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