Enhancing Patient Satisfaction Through Authorization Transparency

With patient loyalty on the decline and the consumerization of healthcare on the rise, it’s more important than ever to give patients an outstanding experience. However, many healthcare providers overlook a key component of enhancing the care experience: the authorization process for treatments and procedures. Clear communication about a patient’s authorization status can significantly boost patient satisfaction and trust. In this blog post, we explore the challenges inherent in the authorization process and how to overcome them so you can communicate more effectively with your most important stakeholder: your patients. 

Common Hurdles in Authorization

While authorization is an essential part of the patient care journey, navigating the process isn’t easy. Recurring challenges providers face when gaining authorization include:

1. Securing Prior Authorization: Insurers require prior approval for certain services to confirm medical necessity.
2. Handling Complex Procedures & Workflows: The paperwork and reviews can be overwhelming, complicated, and time-consuming.
3. Navigating Unclear Guidelines: Confusing guidelines and policy changes can cause uncertainty for providers.
4. Managing Communication Challenges: Miscommunication between insurers and providers can lead to delays or denials, adding to patient stress.
5. Addressing Service Changes: Modifications to services, procedures, or care level can impact authorization.

Financial Fallout

Issues in the authorization process can cause financial stress for both patients and providers. Some common financial impacts include: 

• Unexpected Costs: Without authorization, patients might face significant out-of-pocket expenses.
• Denied Claims: Services without approval can lead to denied claims, leaving patients or providers to cover the costs. 
• Increased Administrative Burden: Managing authorizations consumes time and expensive resources.
• Revenue Delays: Authorization issues can delay billing and revenue collection.
• Unexpected Bills: Surprise medical bills can financially strain patients, affecting future care.

Authorization Transparency Checklist

Effective communication is the cornerstone of patient satisfaction, and transparency in the authorization process can make the difference between a positive and a negative care experience. 

Use the checklist below to help enhance communication between patients, providers, and insurers during authorization process:  

• Streamline Authorization Systems
  • Identify where workflows can be streamlined or steps that can be eliminated to reduce redundancy. 
  • Implement efficient workflows for timely authorization management.
• Develop Clear Communication Methods 
  • Create communication channels that foster open dialogue between providers, patients, and insurers.
  • Personalize patient updates to keep patients informed about their specific cases, especially during delays.
  • Assess patient communication cadence and provide regular updates to help ease patient concerns about treatment approval and mitigate misunderstandings.
• Educate and Empower Staff and Patients
  • Conduct staff training or professional development courses to keep employees up to date on changing insurance and authorization policies. 
  • Provide patient information sessions about insurance guidelines and coverage that impacts their needs. Informed patients are more proactive and engaged in their care.
  • Ensure patients have access to knowledgeable staff for guidance and answers.
• Leverage Technology to Help Automate Tasks 
  • Assess existing technology and resources to understand where automation can help streamline requests. 
  • Use electronic health records and management systems to automate requests.
  • Consider using patient portals or apps for real-time authorization tracking.
• Verify Accurate Documentation Across Authorizations
  • Maintain thorough documentation to support authorizations and appeals.
  • Regularly update documentation to maintain accuracy and prevent errors. 
• Develop Processes to Appeal Strategically 
  • Develop robust processes for appealing denials with clear medical justification.
  • Leverage artificial intelligence (AI) and automation to help streamline denial management.
• Collaborate with Insurers
  • Assess communication methods with insurers to enhance collaboration and navigate recurring challenges.

Enhancing Care with Communication  

As the healthcare landscape evolves, prioritizing clear communication will be key to helping deliver exceptional care. Remember: Transparency isn't just an option — it's essential.

Is your organization looking to improve revenue cycle and the patient experience? Contact BDO today to discuss your needs.