According to HFMA and Eliciting Insights, providers should use these challenges as motivation to partner with revenue cycle management vendors to develop more advanced tools that leverage robotic process automation, AI, and advanced analytics that can eliminate tedious manual processes, and with them, errors that often lead to denials in care.

Gundling says that the best ways to reduce prior authorization requirements and avoid denials are:

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• Understand the specific insurance policies and guidelines


• Gather complete patient information


• Maintain communication channels with the insurance company and patient


• Leverage technology, automation, and artificial intelligence to streamline repetitive tasks and reduce errors


• Track requests, status, and needed follow-up. This includes tracking denial metrics to help improve processes.

The 42-page report is based on survey responses from 135 health system chief financial officers and qualitative interviews with CFOs conducted in the first quarter of 2024.

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