Managing revenue cycles in the healthcare industry is one of the hardest jobs for medical administrators. Technologies like electronic health records (EHR) and patient management systems (PMS) have automated some of the workflows, but they do not cover every critical step.
Any healthcare provider offering services that require prior authorization from insurers will understand how quickly problems can arise. Without clear confirmation of whether a specific service has been approved, patient care may be delayed or coverage denied. Here is how revenue cycle management software like Adonis can help automate this part of the process.
Understanding The Gaps in Current Patient Management Software
There is no doubt that electronic health records and patient management systems have made work easier for healthcare professionals around the world. These tools give physicians and other authorized medical staff instant access to real-time, patient-centered records, including treatment histories and plans, medications, allergies, and laboratory information. Most also hold information about a patient’s health insurance.
Put simply, they help streamline a healthcare provider’s workflow. However, few EHRs and PMSs capture one critical element of the process – prior authorizations for specific medical services. Providers can use their existing patient management software to schedule procedures, but they have no way of confirming or clearly viewing authorization requirements.
Avoidable Insurance Coverage Denials
As a result, patient care and facility revenue suffer. A lack of prior authorization or pre-certification remains among the leading causes of insurance claims being denied. Statistics show that between 2016 and 2020 just over 11% of claims were denied because of prior authorization issues, making this the third most common cause for denial. Only registration and eligibility or missing and invalid claim data scored higher. By 2022, the figure had risen to 13% of avoidable denials.
When health insurance claims are denied, patients face large bills that they may struggle to pay. The stress associated with those may have detrimental effects on their health. For healthcare providers, denials are equally stressful because of their impact on revenue management. Dealing with delayed payments and working with patients to develop payment plans or other alternatives is time-consuming. Plus, like the denial, this additional work could have been avoided.
How Automating Prior Authorization Can Help
Some of the most common problems with current patient management software and prior authorization start even before a procedure is scheduled. Here is an overview:
- Common EHRs and PMSs do not show clearly whether a procedure has been authorized
- Healthcare providers cannot even see whether a procedure requires prior authorization from the patient’s insurance
- Patients do not necessarily know whether their insurance has approved a specific procedure
Add to that the fact that insurance companies will not offer retrospective approvals, and you can see how quickly a difficult situation can arise for healthcare providers and patients.
Automating Prior Authorizations
What looks like a complex problem from a healthcare provider’s perspective is simply a gap in existing software products from the viewpoint of software programming. Adonis revenue cycle management software closes that gap and turns complexity into simplicity for healthcare providers and their patients.
RCM has traditionally relied on medical billing administrators. Automating part of their workflow not only lowers their workload but also delivers better revenue outcomes. Because no two healthcare providers are exactly the same, Adonis offers a suite of automation solutions that can be customized to the organization’s needs.
Automations start right at the beginning of the process by determining whether a patient requires prior authorization for a specific procedure. If they do, the software automatically prompts administrators, ensuring that the healthcare providers secure authorization before delivering specific services. Once authorization has been granted, it is automatically recorded in the system.
Adonis RCM software also generates cost estimates, delivers patient statements, and helps providers mitigate underpayments. Aside from integrating into your existing processes, Adonis can also deliver end-to-end billing solutions and help you leverage the information your organization already has at its fingertips.
How Healthcare Providers Benefit From Using RCM Solutions
Implementing RCM solutions into their revenue management process benefits healthcare providers in several ways:
- RCM streamlines the prior authorization process
- RCM eliminates missed prior authorization requirements
- RCM minimizes avoidable claims denials
Revenue cycle management software automates one of the most critical parts of the medical billing process. By removing the guesswork from prior authorizations, software solutions like Adonis transform the work of healthcare providers, allowing them to focus on delivering excellent patient care without worrying about avoidable claims denials.
Contact us today to request a demo or learn more about how RCM solutions can support your healthcare organization.
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