Efficiency in Hospitals’ Utilization Management to Improve Patient Satisfaction and Revenue
One of the largest and most respected hospitals in the country contacted Infinx after they had run into problems with a patient access vendor in South America. The hospital was perpetually backlogged. It had to reschedule and turn patients away resulting in lost revenue and underutilized equipment. Overwhelmed and frustrated by costly payor delays and denials, the hospital sought a new, definitive solution to chronic prior authorization process inefficiencies and administrative issues, which had been adversely affecting both its patients and physicians for years. They needed a solution that could bring efficiency to the hospital’s utilization management while improving patient satisfaction and revenue.
Processing prior authorization requirements are complicated and labor-intensive. As the only solution in the market that leverages both artificial intelligence (AI) and human intelligence, Infinx guaranteed the hospital that its Patient Access Software solution would authorize every procedure before the appointment occurred, eliminating time-consuming efforts to chase down money after the fact. Additionally, Infinx offered unbeatable price points and experience migrating data from existing, problematic vendors.
Are spent at medical practices per week on tedious and time-consuming prior authorization activities that prevent tending to patient care
Of physicians say that prior authorization programs have a negative impact on patient clinical outcomes, according to a 2018 AMA physician survey
Infinx Patient Access Solution
Our Infinx Patient Access platform helped the hospital get ahead of the revenue cycle problem by quickly authorizing and confirming that every procedure rendered could be billed with near certainty to its accuracy and propensity to collect. The solution is built on Infinx’s proprietary technology platform, Infinx Prior Authorization Software (IPA), which uses AI to automates repeated tasks with workflow optimizations. Exceptions are handled by prior authorization and billing specialists.
Thanks to seamless integration with the hospital’s existing EMR software, the platform was deployed with little disruption to the hospital’s day-to-day operations. We guaranteed strong IT security standards and the overall satisfaction of the hospital’s complex structure of internal stakeholders. Infinx also provided the flexibility of its team of healthcare prior authorization specialists when cases of exception processing required a manual touch.
Planning and Implementation
Our team mapped the hospital’s process and aligned its own process to create a best practice workflow. Next, we studied the hospital’s specific payer nuances and the hospital’s policies of how to handle payer questions. Then, we examined the clinic’s workflow for obtaining additional information for a patient. Once the implementation had been completed, we provided world-class customer support to handle issues, upgrades, and maintenance.
Optimized for Scale with Rapid TAT and Impeccable Accuracy
- Designed for Scale: Infinx conducted 84,000 prior authorizations in six months. During this time, the prior authorization count nearly doubled from 9,500 to 17,500 prior authorizations per month.
- Impeccably Accurate: Infinx conducted 20,152 audits over six months on the prior authorizations performed to measure the accuracy of the solution, and maintained a 99.5% rate of accuracy.
- Continually Optimized: Infinx’s quality group conducted audits that allowed our client to track the agreed-upon metrics so, that our process continued to optimize.
- Rapid TAT and STAT: For standard jobs, the next day and forward, Infinx initiated the request with the payers within 24 hours. For same-day jobs, appointments of same-day minimum four hours out, Infinx obtained a final determination within four hours. For STAT jobs, appointments within four hours of receipt, Infinx obtained a final determination within 30 minutes.
Confidential, Secure, HIPPA Compliant & Medical Necessity
It is standard practice for Infinx to maintain full HIPAA compliance, in both technical security and handling of patient information (PHI). Such standards have been a hallmark of our Infinx Patient Acess platform, and our prior authorization team:
- Fully Encrypted: All PHI stored via iBridge were fully encrypted, per HIPAA guidelines, and stored on Amazon Web Services S3 cloud servers, at secured locations, providing SOC2 compliance documentation.
- Completely Secure: Patient data was never stored longer than necessary, with regular archiving and purging. All files were password-protected and accesscontrolled, as necessary.
- HIPAA Compliant: Prior authorization team members were proficient in HIPAAcompliant standards and protocols, via formal training and periodic reviews. Medical necessity was always observed and followed.
- Regularly Audited: New software updates were thoroughly reviewed and tested for airtight data security, while all technical infrastructure and procedures were regularly audited throughout the year.
- Private and Confidential: The customer’s privacy and confidentiality were 100 percent assured. Industry-standard intrusion detection, up-to-date firewalls. In addition, Infinx Implemented all HIPAA standards and regulations.
98% ACCURACY = PEACE OF MIND
Overall successful authorization rate
Compliance to all payer guidelines, protocols
Error-free audits on all documentation
SLA compliance to STATs, same day and standard appointments
Prior authorizations completed daily
Compliance to HIPAA standards