{"id":3093,"date":"2025-01-15T11:00:00","date_gmt":"2025-01-15T11:00:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=3093"},"modified":"2025-01-15T11:00:00","modified_gmt":"2025-01-15T11:00:00","slug":"qa-can-automated-prior-authorizations-help-providers-meet-new-challenges-in-2025","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=3093","title":{"rendered":"Q&A: Can automated prior authorizations help providers meet new challenges in 2025?"},"content":{"rendered":"

Prior authorizations continue to challenge healthcare organizations as payer authorization requirements expand and change. Automated prior authorizations<\/strong><\/a> can bring new efficiency and consistency to a process that\u2019s ripe for evolution, but how will providers make the leap? Alicia Pickett, Senior Product Manager at Experian Health, shares her perspectives on the issues providers are talking about now: How to speed up prior authorizations and deliver a better experience for users, leaders, physicians, and patients.<\/p>\n

Q: Why are providers increasingly concerned about prior authorizations?<\/strong><\/h2>\n

\u201cManaging prior authorizations<\/a><\/strong> is complex,\u201d Pickett says. \u201cProviders have to deal with different payers, different standards, different service lines\u2014all requiring different pieces of information. Without having all the right pieces in place, it\u2019s hard to drive a consistent workflow. An inconsistent workflow can lead to denials, which can be very costly and affect patient care.<\/p>\n

\u201cOnce denials occur, managing them on the back end through appeals takes more time and additional personnel,\u201d Pickett continues. \u201cCreating a consistent workflow on the front end helps reduce manual work and decreases that denial rate.\u201d<\/p>\n

Prior authorizations are in constant flux. <\/strong>A 2023 survey<\/a><\/strong> by the Medical Group Management Association (MGMA) found that 89% of medical practices find prior authorization requirements to be \u201cvery\u201d or \u201cextremely\u201d burdensome. Of those surveyed, 92% hired additional staff and 97% reported patients experiencing delays or denials. The most common complaints were decision delays, obtaining authorization requirements for routine items or services, and inconsistent payer payment policies.<\/p>\n

Coping with complexity and change puts a strain on manual systems. \u201cInconsistent workflows leave room for interpretation and error,\u201d Pickett notes. One user may be using sticky notes to record information they learned over the phone, while another coworker gets different information from the payer\u2019s website. \u201cThese coworkers aren\u2019t getting the benefit of each other\u2019s knowledge, and their information may not match,\u201d says Pickett. \u201cGiven how frequently payers make changes, these inconsistencies can snowball really quickly.\u201d<\/p>\n

Q: What are providers looking for to deal with prior authorization challenges?<\/strong><\/h2>\n

\u201cClients continue to look for more automation,\u201d says Pickett. \u201cThey\u2019re looking for electronic prior authorization tools<\/strong><\/a> that help users work more efficiently and create consistency. For example, they may want tools to help determine which CPT codes require authorization and which ones don\u2019t. They may be interested in automated processes for follow-up.<\/p>\n

\u201cDynamic work queues, automated auth requirements, and follow-up allow users to spend less time on the phone and more time focusing on complex cases where electronic solutions are not available.\u201d<\/p>\n

When training is time-intensive and staff is in demand, the benefits of automation<\/a><\/strong> go beyond administrative gains. \u201cWhen users are more efficient, they\u2019re not only more effective; they\u2019re also happier in their jobs,\u201d says Pickett.<\/p>\n

Q: How is client feedback shaping Experian Health\u2019s Authorizations product\u2014and how is automation changing the way clients manage prior authorizations?<\/strong><\/h2>\n

\u201cHere\u2019s an example. One of Experian Health\u2019s clients was able to move from a completely manual process, where they were printing schedules multiple times a day and handling inquiries by phone, to an automated prior authorization process using Experian Health\u2019s Authorizations solution<\/a><\/strong>. Now, they have automated work queues updated dynamically, in real-time.<\/p>\n

\u201cThe dynamic work queue allows users to know which accounts they\u2019re supposed to be working on, [even as] patients are being scheduled and rescheduled,\u201d Pickett continues. \u201cKnowledgebase allows users to spend less time on the phone or checking individual portals to find out whether CPT codes require authorizations.\u201d<\/p>\n

In addition to creating more efficient workflows, Experian Health\u2019s Authorizations solution<\/strong><\/a> provides metrics organizations can use to evaluate and plan. \u201cWhen providers use manual processes, leaders and managers aren\u2019t able to gather insights because there\u2019s nothing to tie metrics to,\u201d Pickett explains. \u201cThis client was able to use insights from their electronic preauthorization processes to create greater consistency across their health system. They increased their throughput and managed the process more efficiently with a centralized team. When they were ready to support a new site, they used metrics to guide their planning conversations.\u201d<\/p>\n

Q: What are the major drivers of change heading into 2025? <\/strong><\/h2>\n

\u201cThe CMS rule is going to be one of the biggest drivers of change,\u201d says Pickett. The CMS final rule on prior authorizations was adopted in January 2024<\/a><\/strong>, with many provisions set to take effect in 2026.<\/p>\n

\u201cWhat the rule states is that government payers\u2014Medicare, Medicaid and others\u2014are going to be required to provide information electronically through application programming interfaces, or APIs. Because of the CMS mandate, and because of the options that are available with expanding technology, we expect to see improvement in physician satisfaction and reduction in delays that impact patient care.\u201d Pickett explains.<\/p>\n

These changes should benefit automation. \u201cMore data will be available on what requires an authorization, or on where an authorization stands,\u201d says Pickett. \u201cAutomating messages reduces manual work and human error, and should make transactions more efficient.\u201d<\/p>\n

Meanwhile, several states have created their own mandates.<\/strong> \u201cState regulations provide transparency and require authorizations to turn around more quickly,\u201d Pickett says. \u201cThey may help providers know what to expect, so they\u2019re not left guessing about when authorizations need to be adjudicated and when they\u2019ll be reviewed.\u201d<\/p>\n

Security and privacy are additional concerns.<\/strong> \u201cRecent security threats and breaches are also driving changes,\u201d says Pickett. \u201cFinding and mandating secure connections a key concern. Everyone wants to protect their patients\u2019 data, and rightly so.\u201d<\/p>\n

Q: How will electronic prior authorizations and other advancements impact the future of patient care?<\/strong><\/h2>\n

\u201cWithout question, creating greater consistency and efficiency will have a positive impact on patient care<\/a><\/strong>,\u201d Pickett says. \u201cPatients just want to know that they can get the service they need within the timeframe they\u2019re expecting without issues related to coverage or unexpected cost. A better authorization process provides patients with a better experience.\u201d<\/p>\n

Physicians also benefit from improvements to the preauthorization process. \u201cKnowing what to expect allows doctors to make informed decisions on how to proceed,\u201d Pickett says. \u201cWhen you have transparency, everyone is working together.\u201d<\/p>\n

Finally, users can deliver a higher level of service when electronic processes are in place. \u201cExpecting users to manage these complex processes on their own is a lot to ask,\u201d says Pickett, noting that, with electronic prior authorizations, users are positioned to deal with heavy workflows and take advantage of new advancements on the horizon.<\/p>\n

\u201cAutomating prior authorizations is a big change, but the results can be transformational,\u201d Pickett concludes. \u201cAs we continue to grow, physicians and revenue cycle leaders can focus on keeping their teams informed about what\u2019s happening, whether it\u2019s new payer connections, new information, or new technology,\u201d Pickett says. \u201cStaying informed helps users feel comfortable with the data that\u2019s coming back, so they can trust the process that\u2019s being automated.\u201d<\/p>\n

Learn more about how Experian Health\u2019s electronic prior authorization software, <\/em>Authorizations<\/em><\/a><\/strong>, uses automation to achieve greater consistency and efficiency for healthcare organizations.<\/em><\/p>\n

\nLearn more<\/a>\n

Contact us<\/a>\n<\/p><\/div>\n

The post Q&A: Can automated prior authorizations help providers meet new challenges in 2025?<\/a> appeared first on Healthcare Blog<\/a>.<\/p>","protected":false},"excerpt":{"rendered":"

Prior authorizations continue to challenge healthcare organizations as payer authorization requirements expand and change. Automated prior authorizations can bring new efficiency and consistency to a process that\u2019s ripe for evolution, but how will providers make the leap? Alicia Pickett, Senior Product Manager at Experian Health, shares her perspectives on the issues providers are talking about…<\/p>\n","protected":false},"author":0,"featured_media":3094,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-3093","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3093"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3093"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3093\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/3094"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3093"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3093"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3093"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}