Successfully Automating Orthopedic Patient Access Processes

You hear a lot about automation today—artificial intelligence (AI), machine learning, personnel redeployment, and predictive analysis.  But how do you effectively initiate these game-changing technologies while enhancing your orthopedic practice and effectively engage staff members as workflow and patient encounters evolve and change?

There is no doubt, a delicate balance to successfully automating and upgrading the technology that will help your orthopedic practice run more efficiently and cost-effectively.  But imagine if you see improvements to the patient experience (not to mention your providers and staff) when processes such as prior authorizations and Clinical Decision Support Mechanism (CDSM) certifications are streamlined, obtained, and approved in real-time – no more waiting on hold, faxing endless documents, or following up repeatedly.

Improving the Orthopedic Patient Access Process through Automation

Not to overstate the obvious, but as a specialty, orthopedics relies on primary providers to appreciate their work and refer patients to their door.  And primary providers want to send their patients to a practice that they feel meets the needs of their patients.  What better way to demonstrate competence to the layperson than by professional, streamlined, and efficient patient access procedures?

Prior Authorizations

As insurance companies continually increase or expand their prior authorization (PA) requirements, more and more procedures, tests, and medications are under scrutiny.  Managing the administrative burden can be overwhelming, especially when 88% of all practices still use some form of manual PA processing.

Automating your orthopedic PA procedures ensures faster approvals through AI-driven technology where approvals, follow-up and appeals are all handled electronically except for the few emergent or complicated outliers.  Today’s unified workflow can be integrated through your EHR/EMR using HL7 or API bi-directional communications where your scheduling department is notified in real-time, and patients can be contacted, and procedures initiated immediately.

Clinical Decision Support Mechanism

Beginning in January 2020, CDSM certificates will be required for reimbursement from Medicare for most advanced imaging testing.  Unusually, orthopedic specialists find themselves in a unique situation.  They may be reliant on the primary care provider to initiate Appropriate Use Criteria (AUC) if the orthopedic practice performs the test internally …OR the orthopedic practice may be required to submit information to their radiology partners to inform their billing process if the procedure is ordered and done externally.

Fortunately, there are cloud-based solutions that provide bi-directional integration and are capable of straddling this unique situation.  Additionally, a strong solution would also provide a rich library of AUCs sourced from Qualified Provider Lead Entities (QPLEs) as defined by CMS.

Insurance Verification and Benefits Eligibility

Fully automated insurance verification and benefits eligibility technology allows a practice to vet each patient and determine their all-important reimbursement criteria thoroughly.  Orthopedic practices often perform expensive surgeries as a matter of due course, and initiating or scheduling a patient without verifying their third-party payer information creates a fiscally untenable situation.

Patient Pay Estimation

Patients are assuming more and more of the financial responsibility for their care, and educating them on their portion due prior to initiating a visit, procedure, or surgery is more critical than it has been in the past.  With automated patient pay estimate technology, your practice can provide responsible parties with highly accurate estimations and collect either in full or through a pre-established payment plan before care is delivered.  Without a doubt, a knowledgeable patient is happier with their provider and with their care.

Today’s technology supports orthopedic practices in reducing administrative time and expense so that those employees can be redeployed to higher-value activities, thereby improving the patient’s overall experience.

Contact us to schedule a demo and learn how automating your patient access workflow will improve your practice financial results.



About the Author

Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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