New York Hospital Solves Prior Authorization & Scheduling Overflow with Tech-Enabled Patient Access Solution

Hospital Patients Expect Fast Access to Care

Despite the AHA’s consistent pressure on government legislators as well as medical organizations to encourage payers to standardize burdensome prior authorization requirements, 78% of hospitals surveyed report that their experience working with commercial insurance companies is getting worse.

 

One New York hospital facing staffing challenges decided it was time to line up a partner to handle excess prior authorizations. This hospital’s 29 specialties range from oncology to joint replacement to wound care. Physicians and universities in the community rely on this hospital for diagnostic tests, clinical trials, sleep medicine, and many more.

 

Staffing Challenges Limit Prior Authorization Capacity

 

Even though the hospital had its own prior authorization and scheduling department, it was struggling to keep up with its prior authorization workload. With new limits on overtime and increasing referrals, hospital leaders were concerned that they would fall even further behind on prior authorizations and scheduling. They didn’t want patient care to suffer or become delayed.

 

While getting patients served as quickly as possible is a hospital’s priority, for most procedures, scheduling cannot occur until prior authorizations are approved. As efficient scheduling not only keeps revenues consistent but also fuels patient satisfaction, hospital leaders knew they needed a reliable partner to handle any patient access tasks beyond the capacity of their current staff.

 

Indeed, staff capacity was already creating a problem. Patients were complaining about long hold times and not getting through to a scheduler in the evenings when they could make personal calls.

 

Infinx Chosen as Prior Authorization Partner

 

After evaluating several prior authorization solutions, they asked their colleagues in other hospitals for referrals. One referral led them to select us to handle their prior authorization overflow.

 

Team Gets to Work on Authorizations & Scheduling

 

With our prior authorization solution implemented, the hospital began to send a limited number of prior authorizations directly to us for fast, accurate processing. These requests were mostly for CT and MRI scans and were sometimes emergency requests. The client also began utilizing us as an extension of their scheduling staff. Because we have the flexibility to increase or decrease our workload by request, the hospital didn’t have to worry about fluctuations in volume or under- and over-staffing.

 

Once the hospital provides access to its EMR system, our scheduler logs in and schedules the patient and attaches any documentation that has been shared with us to the patient’s notes.

 

Our AI engine then searches its local, regional, and national payer database to determine if authorization is necessary. We notify our client right away regarding cases that need and those that do not need authorizations. Our solution automatically submits all prior authorizations required, complete with provider details, patient demographic information, and any essential tests and diagnostic documentation.

 

 

 

Hospital Saw Consistent, Real-Time Prior Authorization Updates

 

Our team continuously updated and monitored the hospitals’ prior authorization statuses, ensuring that practice staff knew of all approvals right away. When payers requested a peer-to-peer review or anything else, our specialists alerted hospital staff immediately to follow up. Once authorizations were approved, the information appeared on our online portal.

 

For more intricate claims beyond automation’s limits, our certified specialists intervened. They negotiated with payers, translated the issues to hospital staff, and facilitated the resubmission or document delivery. This two-pronged approach of automation plus specialists ensured all of the hospital’s prior authorizations got processed. With solutions that use only automation, complex authorizations get sent back to hospitals, leaving the time-intensive job of calling the payers to hospital staff.

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Great Performance Leads to Expanding Partnership

 

After seeing how quickly and accurately we handled its prior authorization overflow, the hospital turned to us to help manage patient access for their new orthopedic practice partner. They assigned us not only all of the prior authorizations the practice would need to refer patients to us but their scheduling as well.

 

Today, our staff logs into the hospital’s EMR, and uses any additional information that has come in by email to submit prior authorizations and schedule patients. The group can also directly send us patient information, including prescriptions, notes, and demographics. When we schedule, our specialists also make the call to the patient, go through a questionnaire, and go through the pre-procedure instructions (e.g. fasting).

 

Prior Authorization & Scheduling Work Streamlines and Speeds Hospital Operations

 

Hospital staff and patients are grateful that our solutions have made their prior authorizations and scheduling system more efficient and streamlined. The client recently shared that our workflow has been seamless, reliable, and consistent. They claim that we are so productive, one full-time-equivalent (FTE) from our end does as much work as four full-time employees on their end.

 

Scheduling support has made it possible for hospital leaders to manage staffing challenges and accommodate the referrals coming in from physicians. Staff now quickly handles emergency cases without sacrificing quality of care. Overall, with our support, the hospital can confidently bring on new referring physician groups and accommodate patients from more locations.

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