Prior Authorization Outsourcing Reduces Denials by 40%

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How One Practice Reduced Denials by 40% with Prior Authorization Outsourcing

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A healthcare administrator reviewing prior authorization documents with an outsourcing partner.

Prior authorizations (PAs) are an essential but often time-consuming part of the healthcare process. The complexity of insurer requirements, combined with the administrative burden of submitting and tracking authorizations, can lead to increased denials and delayed patient care. In this case study, we explore how outsourcing prior authorizations helped one healthcare practice reduce denials by 40%. By partnering with Staffingly, Inc., a provider of outsourcing solutions for healthcare practices, the practice was able to streamline its PA process, ensuring faster approvals and fewer denied claims.

Outsourcing prior authorizations with Staffingly, Inc. allowed the practice to tap into expert resources and workflows specifically designed to reduce denials and speed up approval times. With a dedicated team managing the intricacies of PA submissions, the practice not only saved valuable time but also improved its financial outcomes. This real-world success story highlights the transformative power of outsourcing prior authorizations, making it an attractive solution for healthcare practices facing similar challenges.

Key Takeaways

Expertise in Prior Authorization: Outsourcing teams specialized in PAs can improve submission accuracy and compliance with insurer requirements.
Time and Cost Savings: Staffingly, Inc. helped save over 70% on staffing costs while ensuring prompt submissions.
Improved Approval Rates: Denials dropped by 40% due to accurate, well-organized submissions and consistent follow-up.
Enhanced Patient Care: Faster approvals allowed ABC Healthcare Corp. to focus on patient needs rather than administrative tasks.

Challenge: Struggling with Rising Denials

ABC Healthcare Corp., a multi-specialty practice with a high patient volume, faced challenges in managing PAs:

Rising Denial Rates: Nearly 30% of PA submissions were being denied, causing delays in patient treatment.
Administrative Overload: Staff were overwhelmed, juggling PA submissions alongside patient scheduling and insurance verifications.
Revenue Impact: Denials led to unpaid claims, reducing the practice’s revenue and increasing patient dissatisfaction.

Despite allocating internal resources, the practice found it challenging to keep up with the workload and insurer requirements.

Solution: Partnering with Staffingly, Inc.

To address these challenges, ABC Healthcare Corp. decided to outsource their PA process to Staffingly, Inc. The decision was driven by the company’s ability to provide:

Dedicated Experts: A team specializing in PAs, ensuring compliance with insurance protocols.
Tailored Workflow Integration: Seamless integration with the practice’s electronic medical records (EMR) system for streamlined data access.
Real-Time Updates: Regular communication on submission statuses and insurer feedback.
Proactive Follow-Up: Continuous tracking of pending authorizations to prevent delays.

Implementation: A Step-by-Step Transformation with Prior Authorization Outsourcing

Initial Assessment: Staffingly, Inc. conducted a thorough review of the practice’s current prior authorization (PA) processes to identify bottlenecks, inefficiencies, and errors, helping to streamline the overall PA workflow.
Custom Workflow Setup: A dedicated outsourcing team was assigned, seamlessly integrating with ABC Healthcare Corp.’s electronic medical records (EMR) and workflows, ensuring a smooth and efficient prior authorization submission process.
Training and Coordination: Internal staff were trained on best practices for collaborating with the outsourcing team, ensuring optimal results when handling prior authorization tasks and reducing delays or mistakes.
Ongoing Monitoring: Staffingly, Inc. provided monthly performance reports that highlighted key metrics such as submission times, approval rates, and reasons for denials, allowing for continuous improvement in the prior authorization process.

Results: A Dramatic 40% Reduction in Denials

Within six months of outsourcing PAs to Staffingly, Inc., ABC Healthcare Corp. experienced:

40% Fewer Denials: Denials fell from 30% to just 18%, with most approvals obtained on the first attempt.
Faster Turnaround Times: Average PA submission and approval times were reduced by 50%.
Increased Revenue: Reduced denials meant fewer unpaid claims, boosting the practice’s bottom line.
Better Patient Experience: Patients reported fewer delays in treatment, improving overall satisfaction.

Frequently Asked Questions

Q: Is outsourcing cost-effective for small practices?
A: Yes! Even small practices benefit from outsourcing by reducing staff workload and improving revenue flow through reduced denials.

Q: How does Staffingly, Inc. ensure compliance with insurance requirements?
A: Their teams stay updated on insurer policies and leverage advanced tools to verify submission accuracy and completeness.

Q: What happens if an insurance company denies a claim?
A: Staffingly’s team proactively follows up with appeals, addressing insurer feedback to resolve denials swiftly.

What Did We Learn?

This case study demonstrates that outsourcing prior authorizations can significantly transform the administrative efficiency of healthcare practices. By partnering with Staffingly, Inc., ABC Healthcare Corp. was able to reduce denials by 40%, lower costs, and improve both submission accuracy and approval rates. Outsourcing allowed the practice to offload time-consuming tasks to a dedicated team of experts, ensuring compliance with insurer requirements while freeing up in-house staff to focus on patient care. The results show that when practices recognize the limitations of their internal resources and embrace outsourcing, they can achieve measurable improvements in both financial performance and patient satisfaction.

In summary, outsourcing prior authorizations with Staffingly, Inc. enabled ABC Healthcare Corp. to streamline operations, cut costs, and enhance the patient experience. The practice’s success serves as a valuable reminder that leveraging expert outsourcing solutions can lead to faster approvals, fewer denials, and better management of administrative workflows. By tracking key performance metrics and working with specialists who understand the complexities of insurance requirements, practices can significantly boost their bottom line and deliver higher quality care.

Disclaimer

The information in our posts is meant to inform and educate both healthcare providers and readers seeking a better understanding of healthcare processes. However, it is not a substitute for professional advice. Insurance requirements, policies, and approval processes can vary widely and change over time. For accurate guidance, healthcare providers should consult directly with insurers or use professional resources, while patients should reach out to their insurance providers or healthcare professionals for advice specific to their situation.

This content does not establish any patient-caregiver or client-service relationship. Staffingly, Inc. assumes no liability for actions taken based on information provided in these posts.

For tailored support and professional services,

please contact Staffingly, Inc. at (800) 489-5877

Email : support@staffingly.com.

About the Author : Monica Michael is a seasoned Prior Authorization Specialist with years of experience in streamlining insurance processes for healthcare providers. She is passionate about simplifying complex administrative tasks to help hospitals focus on delivering exceptional patient care.