A large orthopedic group on the east coast with over 70 providers at 11 locations provides orthopedic, imaging, rehabilitative, pain management, and primary care services. They offer various studies at their diagnostic imaging locations, including MRIs, CT Scans, Ultrasounds, and full body DEXA scans.
Revenue Leakage Caused By Delayed Prior Authorizations
The stakeholders observed significant revenue leakage due to missed prior authorizations. When they investigated the cause, it was discovered that their patient access teams were overwhelmed with the manual prior authorization process workload. Scheduling patients for diagnostic imaging studies took up to 21 days. This lag time caused patients to move their care to other practices that could obtain insurance approval in a more timely fashion. This left patients and providers frustrated. The patient access team also struggled to keep up with the industry-wide problem of ever changing guidelines coming from a myriad of payers.
Infinx’s Prior Authorization Solution Chosen To Streamline Workflow
Losing patients and revenue due to an inefficient prior authorization workflow was not an option anymore. The orthopedic group decided to investigate automated solutions in the market. After careful discovery, our cloud-based prior authorization solution was selected. We embarked on a 30-day pilot program to facilitate stakeholder participation and acceptance.
They found our ability to scale with volume fluctuations and extensive knowledge base of orthopedic data compelling. Our solution’s analytics and reporting dashboards would allow them to view results in real time.
70% Reduction In Manual Prior Authorization Tasks With Machine Learning & Artificial Intelligence
Our solution was able to automate 70% of the orthopedic group’s manual prior authorization tasks with its combination of AI and patient access specialists.
The Authorization Determination Engine checked patient data and gauges whether prior authorization is necessary or not. This feature uses machine learning and artificial intelligence to assess patient data according to a database of national, regional and state payer rules.
Robotic Process Automation With Exception Handling By Specialists Creates Complete Prior Authorization Coverage
When required, a claim is submitted in near real-time through robot process automation (RPA) with the provider and facility details, patient demographics, and any related tests and diagnosis.
Electronic status checks occur 24/7 until a final resolution is obtained. Exceptions are handled by our in-house trained specialists—creating full coverage leveraged by AI. If additional information or an appeal is necessary, the orthopedic group is notified immediately to assist.
Displays the status of all ongoing prior authorizations and related patient information at a glance.
IPA Case Review
Each case can be viewed as a summary that includes patient information, detailed case status, estimated completion, and more.
Analytics Dashboard Helps Improve Operational Efficiency
Our prior authorization solution’s analytics dashboard helped pinpoint breakdowns in efficiency or areas needing improvement. This allowed the orthopedic group to reallocate workflows to other areas allowing for more work to get done overall.
Making the decision to partner with Infinx to acquire our imaging authorizations was a game-changer. It was a win-win. We increased our internal staff productivity, generated additional revenue and, best of all, our patients received the much-needed diagnostic studies in a more efficient and timely manner.
—Patient Access Manager
$55K Increase In Revenue In Three Months With Lower Denials
The orthopedic group saw an initial increase in revenue of $55,000 in the first three months. With the staff time saved on prior authorizations, they were able to expand weekend hours to see more patients, stemming their loss of patients to competitors.
- 600 prior authorizations processed within 30 days of implementation.
- Prior authorizations turnaround time decreased by 5 days.
- Increases were recognized in productivity for their patient access staff, and error rates were greatly reduced, leading to:
LOWER DENIAL RATES
-50% decrease in denial rates
resulting in more revenue being
collected in a timely manner
80+ hours per week saved,
equal to $100K annually
in administration costs
With the outstanding results brought by Infinx’s IPA solution, the orthopedic group has realized significant ROI through staff resource savings and increases to their bottom line. These changes have been viewed positively by their stakeholders, and IPA continues to support them as they scale their business.