Outsourcing Prior Authorizations Reduces Costs Up to 50%
In today’s complex healthcare landscape, managing prior authorizations (pre-authorization, pre cert) can significantly drain internal resources, time, and efficiency. Every aspect of the billing process—from patient intake to final payment—must run smoothly to maintain financial health and optimize revenue capture. Prior authorizations play a critical role in this process.
Prior Authorization Requirements
Prior authorization requirements ensure that health care services are medically necessary by requiring approval before a service or other benefit will be covered. A prior authorization process can lead to rapid approvals and reimbursements when managed efficiently.
However, healthcare facilities struggle with prior authorizations due to the complex, time-intensive nature of the process. Each insurance company has different requirements, forms, and procedures, making it difficult for providers to navigate. The back-and-forth communication needed to secure approvals often inhibits patient care and increases administrative burdens. Outsourcing prior authorizations is a strategic move that optimizes your approval process and improves efficiency by leveraging specialized experts in navigating complex, time-consuming processes required by various insurers.
Here are the top five reasons healthcare systems outsource prior authorizations to a trusted partner:
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Cost Savings – Reduce Costs Pre Cert Costs by 50%!
Managing prior authorizations internally can be costly. It often requires dedicated staff, training, software, and resources that add up over time. When outsourcing, healthcare providers can reduce prior authorization costs by 50%, paying only for the services they need. This reduces overhead and eliminates the need for ongoing training and technology investments. Additionally, with faster approvals and fewer denials, revenue cycles are shortened, improving the healthcare organization’s bottom line.
“The health care industry spent $1.3 billion on administrative costs related to prior authorizations last year, according to a report from the Council for Affordable Quality Healthcare”
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Denials are Reduced with Access to Prior Authorization Experts
The world of prior authorizations is constantly evolving, with frequent changes in payer requirements and regulations. Keeping up with these changes in-house can be challenging. Outsourcing vendors are experts in the field, staying up to date with the latest industry trends, payer guidelines, and regulatory requirements. This knowledge ensures that prior authorization requests are accurate and complete, reducing the likelihood of denials and improving approval rates.
“According to the American Hospital Association Medicare Advantage insurers fully or partially denied 3.4 million (7.4%) prior authorization requests in 2022. Though a small share of prior authorization denials were appealed, more than 80% of appeals resulted in partially or fully overturning. The requirement of the appeal delays the patient care, and delays may have negative effects on a person’s health.”
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Efficiency and Productivity is Boosted
Handling prior authorizations is a time-consuming process that requires meticulous attention to detail. By outsourcing prior authorizations, healthcare providers can free up their internal teams to focus on patient care rather than administrative tasks. Outsourcing partners are specialized in this area, leveraging streamlined processes and automation tools that result in faster turnaround times. This leads to swift approvals, reduced paperwork, and ultimately, more efficient operations.
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Resources are Scalable and Flexible
Healthcare organizations often experience fluctuations in patient volume, which can lead to unpredictable workloads for in-house teams managing prior authorizations. Outsourcing provides the flexibility to scale operations up or down based on demand. Whether there’s a sudden surge in requests or a slower period, outsourcing partners can adjust resources, accordingly, ensuring consistent service levels without the need for hiring or downsizing staff.
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Patient Satisfaction is Enhanced
Delays in prior authorizations can lead to postponed treatments, causing frustration for both patients and providers. Outsourcing this process ensures that authorizations are handled promptly and efficiently, minimizing delays in patient care. When patients receive timely treatments, their overall experience and satisfaction improve. Happy patients are more likely to trust and stay loyal to their healthcare providers.
Outsourcing prior authorizations is not just a cost-saving measure, it’s a strategic decision that can enhance efficiency, improve patient satisfaction, and allow healthcare providers to focus on what they do best—deliver quality care. By partnering with a trusted prior authorization vendor, healthcare organizations can navigate the complexities of the prior authorization process with confidence and ease.
NYX Health – A Trusted Prior Authorization Partner
Hospitals that use experts for claim management and revenue recovery are positioned at an advantage. NYX Health is a Revenue Cycle Management services company providing comprehensive solutions for individual healthcare facilities, hospitals, and hospital systems. Our services include medical coding, utilization management, eligibility and enrollment, recovery services, and prior authorizations. NYX Health enables their partners to focus on the mission of their facilities, while they efficiently and strategically ensure streamlined services and revenue growth for the hospital. For additional information please call (866) 826-1539, email [email protected], or visit nyxhealth.com.
