ASCs Are Urgently Seeking a Path to Relieve Prior Authorization Bottlenecks

Efficiency is a cornerstone of the ambulatory surgical center (ASC) model: it’s vital to providing a cost-effective hospital alternative and minimizing wait times for procedures.

Yet ASCs, like healthcare employers across the board, face record labor challenges and rising costs that make it hard to maintain efficiency and pre-pandemic business volume. 

Recruiting and retaining staff against the highly competitive backdrop of The Great Resignation can be challenging. Numbers from the Bureau of Labor Statistics’ June 2022 Job Openings and Labor Turnover Summary1 showed more than 11 million unfilled jobs nationwide in March. For ASCs, the clash of staffing shortages and the growing onus of prior authorization (PA) requirements adds another layer of complexity. 

Administrative staff and physicians alike must monitor constantly changing PA rules that vary across healthcare plans. More and more time is needed to manage PA effectively, and it’s time that most ASC staffs just don’t have. Nearly 90% of doctors responding to a 2021 American Medical Association (AMA) survey2 felt overburdened by PA requirements. The study also shows that too frequently, doctors are pulled away from their patients to focus on administrative tasks for an average of 41 PAs per week. 

Despite this vigilance by providers, the PA process can drag on. In fact, depending on the complexity of the request, the level of manual work involved, and the requirements stipulated by the payer, a PA can take anywhere from one day to a month to process, reports Myndshft, a PA automation solution provider. 

“The path to prior authorization is inefficient and littered with roadblocks,” says Ron Wince, CEO of Myndshft. “For example, ASCs must first determine whether a provider-ordered treatment, procedure, or lab test requires payer pre-approval — and policies can differ widely. Digging into the details takes valuable time and adds to administrative costs. Making phone calls, waiting on hold for answers, and back-and-forth emails to verify benefits and determine eligibility is time-consuming and tedious work for front-office staff. Doctors are hit with more paperwork, too, which eats into the time they want to spend with their patients.”

When PA is required, the added duties of collecting plan-specific forms, attaching requested documents, and submitting the request via phone, fax, or email can cause frustration for already short-staffed ASCs. Furthermore, flawed, missing, and outdated information can result in denied claims that stall workflows and slow access to care. 

The impacts of PA reach far beyond the front office and can pose the greatest risks to patients. Physicians report that PA requirements can indirectly interfere with a patient’s ability to do their job and even lead to serious impacts on health. Lacking timely, accurate information about covered procedures, providers, and the portion of the bill that will be the patient’s responsibility, patients often put off needed treatment.

Obtaining PA to facilitate timely care requires efficient, data-driven workflows. Technology can help. Practices are discovering that automated tools can optimize the PA process, placing fewer demands on staff and protecting profit margins. 

Juli Smith, Director at ZOLL Data Systems, recommends a PA tool that will streamline submissions, monitor status, and update information as it is received. “Look for a topflight, end-to-end PA solution that can quickly access electronic medical records (EMR) and populate a patient referral into the payer’s system of use to instantly determine coordination of benefits, eligibility, financial responsibility, and whether PA is required.”

Smith offers this guidance for ASCs:

  • Implement automated PA tools to improve access to care and relieve administrative burden. Pushing paperwork doesn’t add value to the doctor-patient relationship or the bottom line. 
  • Redeploy staff to higher-value activities. Automated PA frees doctors to focus on patients and front-end staff to improve operational efficiency.
  • Consider AR optimization tools to complement PA and improve the patient financial experience. Demographic enhancement tools can find, verify, and correct patient data at the beginning of the encounter. Automated insurance discovery and verification tools identify active coverage prior to submitting PA requests and place primary financial responsibility on payers.

ASCs are transforming outpatient care by offering choice, convenience, and efficiency. In a time when retaining talent and driving down operating costs are top challenges, an innovative mindset can transform the revenue cycle while helping to alleviate these problems. Cumbersome front-end processes can give way to automated processes that deliver long-term benefits. Harnessing PA technology can speed patient access to care, streamline administrative tasks, and maximize revenue so that lean-staffed ASCs can thrive. 

Most importantly, automated PA helps keep the focus on what really matters: providing patients with the best possible care and overall experience.

 

This article is a collaborative effort with ZOLL Data Systems.

 

1 “Job Openings and Labor Turnover Summary: Wednesday, June 1, 2022.” Bureau of Labor Statistics website, July 6, 2022,
https://www.bls.gov/news.release/jolts.nr0.htm.

2 “2021 AMA prior authorization (PA) physician survey.” American Medical Association website, Feb. 10, 2022,
https://www.ama-assn.org/system/files/prior-authorization-survey.pdf.

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Learning Opportunities

Featured Webinars

Featured Whitepapers

Featured Podcast