Ep. 76: What AI can (and can't) do for prior authorizations, with Brad Boyd of BDO USA

Brad Boyd, principal of management consulting at BDO USA, joins the show to talk about how artificial intelligence (AI) and other health technologies are helping physicians navigate the prior authorization process, reduce administrative burdens and improve patient care.

Also, don't miss our special report on 60 years of Medicare, as well as our previous episodes on physician struggles, why physicians are suing RFK Jr., and Medicare reform.

Music Credits:
CHILL LOFI HIPHOP (AGATE LEVELS) NO MEL by Tasty Tunes - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

Introduction to the Episode (00:00:21) Overview of the podcast, episode focus on prior authorizations, and introduction of guest Brad Boyd.

Biggest Pain Points in Prior Authorization (00:01:36) Discussion of administrative burdens, labor shortages, increased denials, and financial pressures on providers.

AI’s Immediate Impact on Prior Authorization (00:04:47) How automation and AI can reduce administrative workload and free up clinical staff.

Rules-Based vs. Generative AI (00:06:26) Differences between rules-based automation and generative AI in revenue cycle management.

Data Requirements for AI Solutions (00:09:26) Discussion on the need for organized, governed data for effective AI implementation.

Provider vs. Payer AI Systems (00:10:54) Exploration of incentives, trust issues, and the divide between provider and payer AI tools.

AI “Battles” and Denial Increases (00:13:23) Concerns about AI systems on both sides increasing denials and administrative gamesmanship.

Integrating AI into EHR Workflow (00:16:14) Importance of embedding AI tools into existing clinical and administrative workflows.

AI Access for Small and Rural Practices (00:19:46) Challenges and opportunities for smaller practices to adopt AI, including reliance on vendors and clinical alignment.

Management Minute: Employee Red Flags (00:21:56) Three red flag behaviors that signal it’s time to let an employee go in a medical practice.

Are We at a Tipping Point? (00:23:09) Discussion on regulatory attention, public uproar, and whether technology can finally solve prior auth issues.

Ethics of AI in Prior Authorization (00:25:40) Ethical concerns, data protection, and responsible use of AI in health care.

How to Start Streamlining Prior Auth with AI (00:28:01) Advice on developing a strategy, prioritizing use cases, and building sustainable AI programs.

Final Thoughts and Emphasis on Strategy (00:32:38) Importance of a thoughtful, long-term strategy for AI adoption in health care revenue cycle management.

Episode Wrap-Up (00:34:09) Closing remarks, subscription reminders, and production credits.