Prior authorization is continuing with the area of the lowest adoption rate. It is with only 21% of the medical plans, which are being fully processed electronically.
The U.S. Healthcare industry is currently missing out on billions of dollars, which are having the potential of annual savings. It is by the manual complementing of the common business translation as per the Council For Affordable Quality Healthcare’s index of 2020.
$16.3 billion could be saved from the workflow automation of the $372 billion that was spent on the administrative complexity of the U.S healthcare system. This is above the $122 billion in the industry, which is already saving from workflow automation. The CAQH report is also using the data from the health plans.
There are also providers from 2019 who are calculating the savings and the opportunities to relate with the verifying of the patients’ insurance coverage. It also includes the cost-sharing, submitting the claims, and obtaining prior authorization. Also, there is the sending and the receiving of the payments.
The saving opportunity is growing with the medical industry for the rising of costs. It is more manual and partially electronic transactions. Also, it is combined with the falling off the costs for the transactions which are electronically powered, as the report says.
However, the potential of the savings has raised by 35% with the opportunity from the previous year. It is up with $9.9 billion and up to $13.3 billion. In the board for the medical plans, the adoption of the fully automated workflow is increasing.
The claim of the submission and the eligibility of the verification benefit are remaining stable. As the authorization continues in the area with the lowest rate of adoption with 21% of medical plans, it has the full electronic transaction for the task.
The medical industry is automated with the processes tracked by CAQH. It could also save up to $43.39 on each patient, as the report says. One significant area for automation is revenue cycle management. More than 90% of CFO in the revenue cycle managers feel the automated tools are important for the revenue cycle.