At the 2019 HFMA Western Region Symposium, Digitize.AI co-founders Justin Adams and Pat Morrell hosted a breakout session, “How A.I. is taking the Pain out of Prior Auths.”
Fifty revenue cycle leaders from across the healthcare industry participated in an interactive survey. Justin and Pat asked the group two questions—and the responses were surprising...
Justin Adams, Digitize.AI CEO, leading a working session with CFOs and revenue cycle leaders at the 2019 HFMA Western Symposium.
Question #1: "What are your biggest headaches related to prior authorizations?"
Responses fell into four main categories:
- Payer Rules, Changes. Ex: "We're told 'no auth is required,' and then we get a denial for no auth
- Patient Downstream Effects. Ex: "At the last minute, the appointment is rescheduled because we can't get the auth in time"
- Clinical Behavior. Ex: "Physician burn-out — plain and simple"
- RCM Teams, Workflows, Systems. Ex: "Decentralized and inconsistent process"
Question #2: "If you had an A.I. solution that automatically administered prior authorizations, what capabilities would be the most valuable?"
There were various responses. Some select answers below:
- "Use A.I. to estimate the likelihood of an auth"
- "Have a robot act as a clinical stand-in for 'peer to peer' discussions"
- "Predict changes in policies and behaviors"