Health IT service provider Availity is set to debut a new pre-clearance service this summer that accelerates the process of verifying authorization for imaging exams, and ensures that patients with high deductibles are aware of their financial obligations prior to or upon arrival for procedures.

The service, announced at HIMSS 2018 in Las Vegas, enables providers to use the full capacity of their equipment while making sure patients are aware of the out-of-pocket costs they owe ahead of procedures. It is carried out through a combination of Availity’s AuthPal and Patient Access solutions.

“Anyone who's walking into an imaging center with a high-deductible plan is likely walking in there owing something between $600 and $3000,” Jeff Chester, SVP and chief revenue officer for Availity, told HCB News. “If you’re on a high-deductible plan, that imaging center has got to figure out how to make sure they collect as much as possible up front. So we are finding in the imaging market that bringing the two platforms together is really, really compelling.”
Collecting high-deductible payments before or when a patient arrives for a procedure has been a challenge for health care providers who traditionally received copays.

Many patients are also under the impression that they are covered by insurance, causing them to just walk out of imaging centers and hospitals when finished with their appointments without paying, a fact that Chester notes can prevent a provider from collecting around 60 percent of the full payment.

The service utilizes AuthPal, an SAAS software that automates the prior authorization process from determination to status with a HIPAA-compliant, secure cloud platform; and Patient Access, a point-of-service collection SAAS software that solves high-deductible inquiries and provides guidance to those collecting payments.

The use of AuthPal reduces waiting time for prior authorization, a process that routinely takes four to five days, to minutes, enabling submission and confirmation of requests in real time. Exams are also able to take place faster, with Patient Access ensuring that patients are aware of their financial responsibilities so they can pay in advance.

Together, both allow patients to avoid dissatisfaction from the discovery of financial obligations after the fact and aid providers in their transition to value-based health care with faster confirmations of authorization and a better cash flow process for such services.

“Satisfaction and consumerism is something that really hasn’t existed in the value chain of health care. Patient financial responsibility is probably one of the biggest dissatisfiers for patients,” said Chester. “So to give them clear visibility on what they owe and payment options makes them really like their provider, because nothing’s worse than after the fact, having a health care issue and trying to resolve a financial issue. You bring sickness and financial together, that’s just a bad place for patients.”

Availity acquired AuthPal through the acquisition of FORE Support Services LLC, a transcription company based in Texas, in April 2017, and Patient Access from RevPoint Healthcare Technologies, a provider of revenue cycle solutions, in 2014.

The solutions are currently sold separately. Availity is collaborating with all payors regarding its pre-clearance service.

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