Post-acute authorization, also known as prior authorization for post-acute care (PAC), requires information from both the referring provider and the post-acute facility taking over the patient’s care. It’s then sent to the payer or convener, who either approves or denies the patient’s post-acute stay. Because it was designed to control unnecessary utilization and ensure the care a patient receives is medically necessary, post-acute authorization is conducted prior to a patient’s discharge to the next site of care, such as a skilled nursing facility (SNF) or acute rehabilitation center.
While post-acute care plays a crucial role in facilitating patient recovery and helping them transition back to their homes or other care settings, there are several challenges associated with the authorization process. Some of these challenges include:
- Coordination and communication among providers: Post-acute care often involves multiple providers and settings, such as SNFs, home health agencies, rehabilitation centers, or hospice care. Coordinating the authorization process among these different providers can be challenging, as it requires effective communication and information sharing to ensure seamless transitions and appropriate care planning. Problems like incomplete documentation, difficulty accessing medical records, or lack of standardized communication channels can hinder the authorization process and delay patient care.
- Administrative burden: The post-acute care authorization process typically involves significant administrative tasks, such as collecting and submitting documentation, navigating complex reimbursement systems, and frequent phone calls and faxes between providers and payers. The manual process can be time-consuming and resource-intensive for healthcare providers, potentially leading to delays in authorization. Without technology, the process can be lengthy and comes at a cost for both payers and providers — often resulting in increased hospital length of stay, lost revenue for avoidable days, and unnecessary readmissions.
Addressing these challenges requires close collaboration between healthcare providers and payers. Streamlining the authorization process, improving communication and information exchange systems, and ensuring clear guidelines for medical necessity can help mitigate these challenges and facilitate timely access to post-acute services.
How WellSky’s CarePort solutions can help
Hospitals are increasingly taking on the responsibility of post-acute authorization and are financially incentivized to streamline their post-acute authorization processes. Not only are hospitals responsible for providing patients with a safe transition to their next site of care, but there are also operational and financial benefits to promptly discharging medically cleared patients and effectively managing utilization in the acute setting.
Many clients using CarePort solutions — including hospitals and health systems, as well as at-risk conveners — are responsible for processing post-acute authorization requests. To streamline this workflow, CarePort’s solution for prior authorization for post-acute care, embedded within the discharge planning module that hospitals already use, provides hospitals with the following benefits:
- Real-time notification of post-acute authorization approvals and denials to post-acute providers
- Clinically relevant, clearly presented, and well-organized information accessible from the referral packet to be sent to the payer for authorization
- A centralized location within the hospital’s EMR to document all post-acute authorization activity, further streamlining the discharge process
- Improved visibility into the post-acute authorization process
- Robust reporting capabilities, allowing acute and post-acute providers to understand staffing needs and negotiate with payers
Electronic post-acute authorization helps ensure that patients receive the right care in the right setting, while helping to manage costs, reduce readmissions, and improve outcomes.
Learn more about how your organization can leverage post-acute authorization to expedite and streamline patient transitions and authorizations to the appropriate next level of care.