Prior Authorization Challenges Facing Orthopedic Practices

Did you know the average revenue orthopedic surgeons generate is $2.7 million?

Now–averages don’t paint the whole picture. Your orthopedic practice might generate less, more, or in and around the above amount. 

Moreover, revenues and profits aren’t the same. 

Your orthopedic practice could earn more than the average revenue yet generate a loss profit come year-end. Factors such as overhead and your ability to maintain efficient operations will dictate whether your practice can thrive, continue growing, and keep providing optimal care.

Part of cultivating a consistently profitable practice is fine-tuning your revenue cycle management processes, including prior authorizations–the topic of this article.

These administrative burdens can present roadblocks for your orthopedic practice, impeding your productivity and efficiency and diminishing your bottom line. We’ll examine these issues below:

A Brief Overview Of Prior Authorization

While anyone running an orthopedic clinic will be familiar with prior authorization, it’s always helpful to review the specific details.

Prior authorizations are doled out by insurance companies. They’re typically for more complex prescriptions or treatments (like orthopedic care). They are required for a given type of care to be delivered. Coverage isn’t provided without prior authorization for the treatments and procedures in question. 

Theoretically, prior authorization is a net positive. It mitigates the likelihood of costly, inappropriate, or unsafe procedures and treatments.

Yet, theory and reality are often at odds in most facets of life, including when running an orthopedic clinic. While prior authorization is a safeguard in many ways, a lack of centralized approaches and streamlined systems turn it into an overbearing administrative burden.

Why Are Prior Authorizations So Inefficient At Orthopedic Practices?

Any given orthopedic clinic or facility can have a patient who needs service while multiple service lines are overrun. Considering the staff shortages plaguing the sector, you can already see the systemic issues involved with–and plaguing–prior authorizations. 

Also, when you’ve got to wait on a third party to approve something, challenges will almost always be soon to follow.

It’s not like utilization management and payers make the prior authorization process any easier. They don’t seem concerned about the time they wait and the inefficiencies they catalyze. 

For instance, spine surgeon David Gendelberg, MD, explains how receiving prior authorizations for simple tests cuts directly into the time he can spend with patients. 

Dr. Gendelburg is not alone in his struggle. According to the American Medical Association, 86% of care providers cited the prior authorization process as creating a burden that swallowed up approximately two business days per week. 

Additionally, almost 30% of survey respondents claimed that inefficient prior authorization processes led to a severe adverse event in their facility or practice.

Spending On Prior Authorization Is A Glaring Systemic Issue.

The national system in and of itself spends $15 million monthly on administrative fees dealing with health plan contracts. Related funds are–in part–allocated toward two to three full-time staff who only focus on monitoring plan bulletins for rule changes.

Suddenly, the average $2.7 million brought in by orthopedic surgeons each year seems insufficient in the face of surging administrative costs.

Streamline Your Pre-Authorization Process And Optimize Your Revenue Cycle Management With Adonis.

At Adonis, we’ve developed a Revenue Cycle Automation tool that utilizes artificial intelligence and machine learning to reduce the administrative burdens of prior authorization. 

Our technology ensures that claim denials due to a lack of authorization aren’t a factor because it identifies services that will require authorization prior to a patient’s visit.

Adonis’s Revenue Intelligence combined with our Prior Authorization solution delivers a  highly productive prior authorization process, freeing up time for you and you staff to care more for your patients. 

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Request a free demo to learn more about the significant, positive impact Adonis’s technology can have on your orthopedic practice.

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