NPC Creative Services

Efficient patient access is paramount for physician practices in today’s evolving health care environment. When patient access and financial clearance processes are outdated, the resulting inefficiencies create delays in the patient’s journey from initial contact to care access – delays that contribute to revenue leakage and can impact patient satisfaction.

Yet many physician groups are struggling to streamline and improve patient access operations, thanks in part to chronic staffing shortages, rising patient volumes, and more complex prior authorization requirements. As a result, they are falling short of core financial clearance benchmarks.

The prior authorization process has evolved in complexity as the healthcare industry transitions from fee-for-service to value-based care. At the same time, payers are expanding the number of services subject to prior authorization to establish medical necessity and appropriateness. It’s a one-two punch that leaves providers and provider organizations struggling under the weight of a prior authorization burden that, left unaddressed, can have long-term revenue cycle impacts.

Today’s prior authorization process involves time-consuming steps, including gathering and submitting medical documents to insurance companies and waiting for approval. It also often involves dealing with denials and appeals – all while guidance around required documentation becomes stricter.