Streamline Legacy Accounts Receivable Resolution
In the field of oncology billing, prior authorization (PA) is a vital element that plays a crucial role in maintaining the delicate balance between delivering cancer care and guaranteeing financial stability. In a recent study of 700 oncologists, difficulties were noted by 31% of patients who reported delays longer than four to five days, and 93% of patients who experienced delays in crucial therapy because of PA requirements. This report, which was released by a number of medical associations, attempted to draw attention to the expanding problem of Oncology Prior Authorization in medical billing services.
PA was once designed to save expenses and shield patients from unforeseen bills, but it has unintentionally resulted in more claim denials, administrative difficulties, and delays in patient care. These difficulties have a negative financial impact on providers and put patients and billing staff under unnecessary stress.
It is complex to address the underlying causes of administrative burdens, claim denials that lead to write-offs, and delays in the processing of claims, especially in light of the growing PA demands from payers.
Putting the following strategies into practice to maximize oncology billing:
1.Automated Systems for Patient Financial Responsibility and Eligibility:
- Early in the revenue cycle, integrate AI-enhanced, real-time PA technology to eliminate errors, streamline manual labor, and expedite patient care. This includes the capability to autonomously ascertain whether PA is necessary and choose the best submission path.
2.The end-to-end method:
- Create a completely integrated strategy that includes a master patient index (MPI), real-time connectivity to the majority of payers, a large payer rule library, and system integration with EHR, LIMS, HIS, and RCM solutions, among other things. Include a self-learning system that updates automated process and rules engines dynamically using AI and real PA reactions.
3.Automated Revenue Optimization Tools:
- To improve efficiency, incorporate tools for insurance finding, self-pay analysis, deductible monitoring, and demographic verification.
Prioritize the following crucial tactics in order to maximize oncology billing:
- The Gold Card System: By following payer rules with knowledge, clinicians can lessen the need for prior authorizations, freeing up important time for tasks that are higher on the priority list.
- Automation of Prior Authorization: In line with the CAQH report’s recommendation to expand electronic submission, use automation to improve the precision and effectiveness of the pre-authorization process.
- Systems that are transparent between payers and providers: Encourage open and honest communication about prior authorization policies and supporting documentation between payers and providers. Make use of programs like CMS’s safe environment to quickly determine the demands of PAs
- Acceptance of Authorization from Prior Insurer: When a patient switches insurance, streamline the process to guarantee prompt care and cut down on wasteful spending.
- Accelerate Previous Approvals: Overcome the delays brought on by outdated systems and manual processes.
What to look for in a medical billing service’s Oncology Prior Authorization:
- Engages in programs that promote value-based care
- Respects NCCN Guidelines when providing care
- approving a patient’s coverage and treatment expenses
- obtaining access to doctor’s orders
- Information gathered as needed by insurers to submit requests for prior permission
- Doctors receive information in real time.
An end-to-end, fully integrated strategy consists of:
- An MPI, or master patient index, that is able to recognize every single patient
- Fast and easy access to the majority of payers
- A vast collection of payer regulations that harmonizes PA and eligibility standards
- Integration with systems and workflows such as revenue cycle management (RCM) software, LIMS, EHR, and health information systems (HIS)
- A self-learning system that dynamically updates automated process and rules engines using artificial intelligence (AI) in response to real-time answers and outcomes from supplied PAs
- Integration with automated revenue optimization technologies, including deductible tracking, insurance finding and verification, self-pay analysis, and demographic verification
- The ability to immediately submit a PA request, validate it against payer criteria, and get a decision right away from the payer.
- Providers can use AI-enhanced, real-time PA technology to drive the end-to-end PA process as early in the revenue cycle as feasible, building upon automated eligibility and patient financial responsibility systems.
Five essential tactics to increase pre authorization in order to maximize oncology billing:
1. The gold card system
- Prior authorizations are not necessary for healthcare professionals that follow the payer’s specific guidelines and are well-informed. According to reports, doctors spend an astounding fifteen hours a week on previous authorizations. Even a half-hour reduction in this time could have a significant impact, allowing you to devote more of your valuable time to higher priority duties.
2. Prior Authorization Automation
- One of the most effective methods for streamlining and enhancing the precision of the pre-authorization procedure is automation, which finds the best course of action or drug swiftly. According to a research by the Council for Affordable Quality Healthcare (CAQH), just 12% of prior authorization requests and 100% of claims are submitted electronically.
3. Clear and transparent systems that connect payers and providers.
- The process would be streamlined if payers and providers had open and honest communication about what services require prior permission and what supporting documentation is needed. The Centers for Medicare & Medicaid Services (CMS) have launched an initiative to support this drive, which enables providers to communicate with the payer platform in a secure environment and quickly determine whether a particular process requires prior authorization and the necessary documents for the operation.
4. Acceptance of the Authorization from the Prior Insurer
- A new procedure and repeated protocols are typically needed before treatment when a patient switches health insurance providers. This can have a significant influence on the patient’s health and result in higher treatment expenses for the physician. In addition to saving unnecessary expenses, establishing a streamlined procedure for accepting the prior authorization from the prior insurer may help ensure that patients receive care on time.
5. Accelerate Previous Approvals
- Patient care and results may suffer as a result of the pre-authorization process’s severe slowdown caused by manual procedures and antiquated systems. According to a research by the American Medical Association (AMA), over 65% of physicians experienced a delay in the prior authorization process of at least one day, and 27% reported a delay of three days or longer. Patients frequently stop their treatments as a result of this wait, which can be avoided by using automated systems to expedite approvals.
In conclusion
It is imperative to optimize oncology billing and ensure efficient claims processing by streamlining prior authorizations. Oncology practices can better manage the intricacies of prior authorizations, avoid denials and delays, and ultimately enhance patient care and financial performance by putting strategic strategies into place.
Are you prepared to enhance your cancer billing and simplify the Prior Authorization procedure? Take the next action to manage healthcare more effectively and efficiently. Get in touch with us right now to discuss custom solutions that improve patient care, cut down on delays, and improve financial results. Here is where your journey to seamless oncology billing begins. Together, let’s improve your practice!
Published By – Provider Billing and Coding
Published Date – Feb-29-2024