Administrative Staff Overtime and Resource Waste in PA Processing

$1,000-1,400/week (CDI labor × incomplete query cycles; 7% submission failure rate = $156K/year revenue loss from delayed/denied PAs on 4,000 annual cases) • $1,000–$1,800 per physician per month in avoidable labor and overtime for prior auth handling, based on ~13 hours/week of low-value admin time and 39 PA requests/week being worked largely by staff instead of being automated. • $1,000–$1,800 per physician per month in excess labor tied to government-plan PA volume, with additional soft losses from delayed care slots and staff turnover risk due to burnout.

AR Manager calls ED physicians after-hours to document medical justification; escalates via phone to payer medical directors; manually reformats clinical notes into appeal language • AR Manager maintains relationship-based email/phone contact with payer appeal specialists; tracks conversation notes in Outlook Tasks; escalates to network contracts if denial recurs • AR Manager manually schedules P2P calls; compiles clinical summary via Word doc cut-paste from EHR; tracks P2P outcome in Excel; re-files appeal if P2P unsuccessful