Lost Patient Care Capacity Due to Prior Authorization Bottlenecks

$103,000 annually per FTE from multi-system VBO PA data consolidation; $189,000+ from unclear VBO performance impacting member retention • $103,000 annually per FTE from referral coordination delays; $267,000 from lost referral revenue due to care delays (93% experience delays) • $112,000 annually per FTE from Medicare-specific PA research overhead; $201,000 from lost patient revenue due to treatment delays and patient cancellations

Billing manager and care coordination staff manually reconcile payer PA rules with value-based contracts using spreadsheets and emailed care plans, then submit and track PAs through standard portals and faxes. • Billing manager and clinical staff manually track PA status outside the EHR using paper folders, shared Excel trackers, payer portals, fax confirmation sheets, and phone logs to avoid losing authorizations in the backlog. • Billing manager keeps separate cheat sheets for Tricare rules, uses Tricare portals and faxed forms, and tracks approval timelines in Excel or calendar reminders to avoid expired authorizations.