Infinx Healthcare is pleased to partner with ScriptSender, a leader in enabling secure, one-click interoperability between healthcare providers, to solve two of the most labor-intensive issues in the radiology workflow: automation of the Clinical Decision Support Mechanism (CDSM) compliance certificates and Prior Authorizations. With this complimentary suite of technology services, a machine learning-enabled system is created that can integrate with a radiology group’s RIS and EHR/EMR to provide a state-of-the-art automated workflow.
We believe that by integrating with strategic partners with core competencies, like ScriptSender, financial management is enhanced end-to-end, delivering maximized revenue and profitability by utilizing AI-driven technology. With margins shrinking and reimbursement rates falling, the resultant increased reimbursement, streamlined processes, and reduced denials will positively impact the bottom line.
The Flexibility of Today’s Technology
As patients are referred to a radiology group, ScriptSender establishes secure, instant integration with the referring providers’ EMR. Any document can be sent to the imaging center with a single click from any application and any medical group. Infinx streamlines the prior authorization and CDSM workflow by leveraging automation and artificial intelligence (AI). When combined with ScriptSender’s ability to deliver digital data across platforms, the result is greater control over the revenue cycle—for both referrers and imaging providers.
The cloud-based solutions Infinx CDSM Solution is fully integrated with the Infinx Prior Authorization Software, are designed to preserve and increase revenue by streamlining the complete CDSM and prior authorization workflow while improving the overall patient experience.
- Referring physicians use the ScriptSender print function to send HL7-formatted imaging orders and clinical notes into the RIS and Infinx.
- Infinx verifies the patient’s insurance benefits, determines whether a prior authorization is needed or not with their proprietary Authorization Determination Agent, and initiates the process in real-time.
- ScriptSender and Infinx use AI to determine exactly which data elements are required by the payer, and it sends that data to the payer or radiology Benefits Manager for approval of the request.
- Once approved, Infinx delivers the exam information to the scheduling team. A follow-up workflow ensures that appeals and incompletes are handled expeditiously.
Streamlining Radiology Prior Authorizations
As the menu of available imaging tests continues to grow, so do radiology prior authorization requirements. While preauthorization responsibilities may rest with the ordering provider, often they are missing, or patient information is incorrect, creating a cascading follow-up process that wastes time and can impact patient care.
By moving expectations to the point of care delivery, prior authorizations can be processed before testing is even done. With an AI-driven software solution fully integrated with the group’s RIS, required prior authorizations can be isolated, approvals initiated and sent, follow-up performed 24/7, and notification of successful resolution returned to the group in real-time.
Using an intelligent automated system significantly reduces the need for burdensome manual follow-up (i.e., waiting on hold, faxing and refaxing, etc.), saving time and resources. A process that historically has taken anywhere from several hours to days or even weeks can now be accomplished in minutes.
To illustrate even more clearly, the 2019 CAQH Index looked at the average cost per transaction for manual versus fully-electronic prior authorization transactions and found that automating the process would save an average of $9.04 for providers. Couple with estimated savings for insurance payers of $3.27, and the industry-wide savings per prior authorization would be $12.31. Add that savings to the increased revenue recognized as denials and write-offs decline significantly, and intelligent automation solutions speak for themselves.
Most importantly, not only will this increase and accelerate the reimbursement cycle, but it should greatly improve the patient’s experience and confidence in their care.
With today’s advancements in technology brought together through our partnership with ScriptSender, radiology providers can facilitate patient access and improve their bottom lines through reduced costs and much greater revenue capture. When weighing the benefits of these technological advancements, consider that the financial savings recognized by applying automated and AI-driven software solutions far outweigh the cost for acquisition and implementation, both in terms of labor required and realized revenue.
Learn more about this exciting partnership with ScriptSender and contact us to discuss AI solutions that improve your radiology revenue lifecycle and streamline the business operations process.