How Advantum Health is tackling prior authorization burdens

Advantum Health's new top leaders are focused on technological solutions as health systems struggle to find enough staff to handle the demands of revenue cycle management. 

In November, Tammy Taylor was appointed CEO of Advantum Health, and Chris Taft was named CFO. 

Louisville, Ky.-based Advantum Health was founded in 2013 and provides a variety of RCM services. 

The two leaders sat down with Becker's to discuss the biggest challenges providers are facing, and some possible solutions. 

Question: More hospitals and health systems are choosing to outsource their revenue cycle management. Why is this, and do you think this trend will accelerate in the coming year? 

Tammy Taylor: Labor shortages are definitely happening. I think everybody in our world, in the universe we play in, definitely understands that. Getting good people has been tremendously tough recently. We set out to say we want to hire the best — which everybody does, right? But we also want to make them as efficient as possible. 

We're really focused on merging technology and humans, letting humans manage that technology and making sure, with the shortage of people in the industry, that we can make up some of that shortfall with technology. If it's artificial intelligence with RPA, predictive analytics, whatever it might be, we're making sure that we're investing. I think we've probably tripled our investment this year. 

Chris Taft: A small hospital or health system, it takes a lot of investment in technology to be able to utilize that to offset some of the cost of labor. Labor's not getting cheaper, it's harder and harder to source and find and retain. I think being able to outsource that, to find a partner or vendor that's invested in investing, is already ahead of the curve on that portion — that's where we see a lot of wins in those conversations with prospective customers or existing customers. 

Q: You work with mid-size, independent providers. What are the biggest challenges those providers are facing, in terms of revenue cycle and administrative burden? 

TT: It's just a lot. It's a lot of paperwork, a lot of documentation. We handle a lot of them so they don't have to do all that, that they do in their EMR, and then come back and do in their practice management system as well. Us being able to step in and do that and be their true back office and them not having to worry about if so-and-so is off for the day, or this person called in sick, because we have that overlap. It makes it less stressful for them. 

CT: I think we're seeing a lot of folks in the industry struggle with prior authorizations. That's a service that we believe fully in and we're staffed with technology around that as well. Provider enrollment, and credentialing, making sure people are enrolled with the provider, with the payers with no issue — that's the first step in our process, from a revenue cycle standpoint. 

We see issues there, and that's a service that we really try to hone in on, because if there's an issue there, no one gets paid. 

Q: From your perspective as revenue cycle leaders, what can be done to reform prior authorization? 

TT: Definitely more standardization. Right now, I have payers who have different rules and regulations. It's all around what's best for the patient — they should be getting their information from a definitive source, right? And we're not seeing that. 

We document all of those rules and all those regulations that the payer has, and we put them in our tool, and we're able to sort of stay on top of it, but they change all of the time. If you meet all the requirements, and the requirements are posted and they're standardized, then we're going to make sure it happens. We're going to make sure that it's complete and we're addressing all of those areas. When there's no standard, it's all over the place. So we'd like to see the industry as a whole come up with a standardized program. 

CT: From an internal process standpoint, we tried to standardize things internally, based on the unstandardized methodology. That's why we developed tools internally to make it as standardized as possible inside our four walls. But if the industry itself gets standardized, it would make our job a lot easier, as well as provide better care and satisfaction for patients. 

Q: What is the biggest challenge providers are confronting in revenue cycle now? 

TT: Definitely the fee schedule changes, things like that. … Shortage of staffing. They just can't keep up. They're looking for some type of recovery. I'm not a staffing company, but I can provide the service. That's where we've been talking to quite a few clients about how we can help them provide that service. That's the No. 1 thing I heard. 

And again, prior authorization. It's getting to the point where you don't even know if your surgery is authorized until the day of or the day before. That's stressful to the provider, it's stressful to the patient, it's stressful to the hospital or the ASC.

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