The most expensive and time-consuming prior authorization process is simplified using robotic process automation. Hospitals and health systems are successful in implementing RPA.

1. HOW DOES RPA ENABLE
PRIOR AUTHORIZATIONS
TO IMPROVE HOSPITAL’S
BOTTOM LINE?
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2. INTRODUCTION :
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The expense of prior authorization on doctors and hospitals has
kept on expanding by 60% in 2019 to manually produce a request
for the insurers.
The CAQH Index released in 2019 stated that the healthcare
industry can save $13.3 billion on administrative waste through
robotic process automation of eight pre and post RCM processes
including prior authorization, the hospitals and health systems could
see likely yearly savings approximately in the amount of $454 million
by transition into robotic process automation (RPA) prior
authorization implementation.

3. MANUAL AUTHORIZATION PROCESS VS
RPA ENABLED AUTHORIZATION PROCESS
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Let’s take a look at what the manual prior authorization process looks like,
typically the process begins when a prescription or procedure is submitted
into an order entry system, the nurse, front office staff, biller or admin then
identifies the patient and his or her insurance provider and needs to validate
whether or not the prior authorization is required for the requested
prescription or procedure and it takes at least 2 hours without implementing
robotic process automation (RPA).
Typically it involves the nurse, front office staff, biller, or admin accessing the
insurance company’s online portal and browsing a list of prescriptions or
procedures to determine whether the prior authorization is required. If it is
determined that his or her prior authorization is required, the nurse, front
office staff, biller, or admin will begin collecting the required patient
information from various healthcare provider systems to populate the
prior authorization requests once completed.

4. The prior authorization form is submitted and routed to the
insurance provider. This process is repetitive and cumbersome with a
great deal of swivel chair data entry involved for the prior
authorization specialists or nurses. Prior authorization is a
prerequisite that your hospital or healthcare provider (specialist,
clinic, and so on) gets reimbursement from the patient’s health care
coverage plan prior to recommending a particular procedure or
prescription for the patient or carrying out specific treatment.
Without this prior approval, the patient’s medical coverage plan may
not pay for your treatment, leaving the patient responsible or liable
for the bill.
RPA-enabled prior authorization processes undergo the same steps
as the manual prior authorization process. It’s just that RPA bots are
much more capable of verifying patient health plans and their history
to identify whether a particular service is approved by the health plan
in a much faster and more efficient way. It takes approximately 2-5
minutes for an RPA bot to complete this process and also file the
application on the respective insurance portal.
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If the health plan required any further information such as diagnosis reports
and patient history or any doctors correspondence of the particular
treatment, the bots will raise a query if it needs to be provided by the treating
physician or if the records are readily available the RPA bots will go ahead and
submit those records immediately preventing timely filing issues. The reason
why we need to emphasize this is because most hospitals will be
overwhelmed by the number of prior authorization denials or requests for
additional information and might miss to follow up. The hospital might be
responsible for not obtaining prior authorization in time.
TIME DIFFERENCES BETWEEN MANUAL AND
RPA ENABLED PRIOR AUTHORIZATION
For example, A hospital has more than 50 surgeries and inpatient volumes
per week, and all these patients required prior authorization. Calculating the
hours of successful action for filing authorization is 2 hours per patient, so on
average manual prior authorization process requires 100 hours of manual
work. The same process handled by RPA bots will take anywhere between 4-5
hours to complete the filing of authorization for all the 50 patients.

6. This saves lots of time which can reflect positively on the patient as they receive timely care and they may also refer other
patients to your hospital increasing patient volume simultaneously.
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HOW DOES RPA-ENABLED PRIOR AUTHORIZATION BENEFIT A HOSPITAL?
The Medical Group Management Association (MGMA) said the CAQH report affirms its own concern about the financial and
staffing burdens of the prior authorization process and it directly affected the hospital and physician’s ability to perform the
services required to the patient at the time of illness. The CAQH index identified and ensured that MGMA’s calculations
uncovered that the expense for hospitals to physically produce a prior authorization request expanded from $6.61 in 2018
to $10.92 in 2019.

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Hospital cost for a similar process was reduced from $3.50 in 2018 to $3.32
in 2019. Simultaneously, the expense for hospitals and health systems to
produce an RPA bots-assisted prior authorization transaction dropped
from $2.80 in 2018 to only $1.88 in 2019, and the expense for hospitals
reduced consistently year after year after implementing the robotic process
automation for the prior authorization process.
RPA-enabled prior authorization has proven results. It’s high time that
hospitals and health systems adapt to the changing digital transformation
that not only delivers quality, productivity and efficiency but also increases
patient care satisfaction as they will be confident to rely on your hospital to
perform the necessary due diligence. BillingParadise has certified RPA
specialists who have experience both in programming RPA bots and
healthcare RCM. Having this hybrid model allows us to answer all the
questions related to implementing robotic process automation.
Learn more about robotic process automation in revenue cycle
management, and schedule a virtual call with our experts!

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9. CONTACT US
Phone Number
+1 888-571-9069
BillingParadise 24x7 INC, 53 Emerald Road,
Robbinsville, NJ 08691, United States.
Address
Email
inquiries@billingparadise.com