Every year, prior authorization delays and denials become a bigger problem for urology practices. In the most recent American Urological Association survey, 75 percent of urologists rate the prior authorization burden as “high” or “extremely high,” and 90% say that patients have been harmed due to delays in care caused by prior authorization issues.
Even small practices struggle to keep up with prior authorizations. One of our urology provider clients, a single-location practice in the Midwest, specializes in incontinence, vasectomy, and BPH outpatient procedures. Their size means each employee handles several, often disparate, roles. Because the clinic had fallen behind on prior authorizations, the doctor sought to outsource this task.
Manual Prior Authorization Process Causes Patient Care Backlog
Handling significant patient care work, the practice manager found it challenging to manually complete 10 prior authorizations every day, and the prior authorization requests became backlogged.
Patients’ pressing concerns of course took priority, even if they interrupted the prior authorization process. Constant interruptions, however, caused time-consuming task-switching and stretched the time to complete each prior authorization request.
The time to manually complete prior authorizations was just one of the challenges involved, however. When the staff at a small practice have multiple roles, they need the knowledge it takes to effectively carry out the duties involved in each.
Accurately processing urology prior authorizations with a diversity of CPT codes is complex. With payer policies changing every year, it is difficult to stay on top of all the updates. .
The practice manager began a search for an alternative solution. After finding us on the athenahealth marketplace, they were pleased that we had experience with both athenahealth and urology prior authorizations.
Patient Access Plus Chosen To Manage Prior Authorization Workflow
Many small, single-doctor practices partner with us to remove just one in-depth task from their staff workload. Showing the clinic that other small practices were achieving positive returns on their investments in our services also impressed them.
Waving off a pilot program and trial period, the practice chose our Patient Access Plus technology plus specialist solution to take over all prior authorization submissions, follow-up and resolution.
Authorizations Submitted And Approved On Time
Onboarding was simple with our easily accessed web-based portal, and the office manager was happy to hand over the bulk of their prior authorization workload.
After she enters patient demographic information, our AI engine determines whether a prior authorization is necessary or not. After searching its national, regional, and local payer database, it finds that payer’s current guidelines regarding the relevant procedure.
When a prior authorization is required, our solution submits an authorization request with all the patient demographic information, tests, and all diagnostic documentation requested by the payer. Once the prior authorization has been submitted, our solution performs frequent status checks and provides turnaround time estimation. If additional documentation or a peer-to-peer is required, our specialists alert practice staff immediately in the portal and by email.
Streamlined Prior Authorization Process Alleviates Staff Workload And Improves Turnaround Times
With prior authorizations removed from her task list, the practice manager now can take better, more focused care of their patients. Our proactive communication helps her feel like she has a partner she can depend on. Cutting prior authorization turnaround time to hours or days rather than weeks has relieved their staff and patients alike.
The office manager especially appreciates the clear notes provided by our operations teams – saving her hours on the phone if she has to work with payers. She also appreciates how simple and straightforward navigating our solution is. Overall, the practice is thrilled with our solution and quality of service.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Are your practice’s prior authorizations backlogged due to staffing limitations? See how one small urology practice uses a cost effective tech plus specialists solution to manage its prior authorizations.