Our client is a respected orthopedic practice in the Great Lakes region, providing treatment for injuries and conditions involving the back, neck, spine, foot, ankle, hand, elbow, shoulder, wrist, hip, knee, and joint replacement. They also specialize in sports medicine, joint reconstruction, nonoperative care, and pain management. They provide customized treatment plans focused on patients’ needs and goals to keep them healthy and active. The practice also offers in-house 3T MRI services and comprehensive therapy services, including physical, hand, and massage therapy.
Losing A Key Prior Authorization Specialist Amid A Labor Shortage
The practice was running smoothly until their experienced prior authorization specialist suddenly left. This departure left a significant gap in their operations, causing a backlog in processing prior authorization requests for orthopedic surgeries. They were weeks behind in processing requests, causing scheduling issues and increasing stress among the team.
It was a major challenge to replace the specialist due to a labor shortage in their community. Her role was critical, requiring a deep understanding of the various surgeries scheduled for all the doctors.
Stressed Out Staff and Backlogged Prior Authorizations
Each day, their former specialist ran reports to identify scheduled procedures for all doctors as well as MRIs and CAT scans. She worked on authorizations for these procedures and kept track of the changing clinical guidelines for the many payers they worked with. To ensure timely authorizations, she worked at least a month ahead- a challenging responsibility that was virtually impossible to delegate.
After her departure, the workload was divided among team members from their billing department, taking time away from important billing tasks and leading to missing and inaccurate authorizations.
Discovering Infinx Through AAOE Listserv
In the face of these challenges, the practice decided to explore outsourcing options. They discovered Infinx through the American Alliance of Orthopaedic Executives (AAOE), a premier professional organization providing resources and education to orthopedic practice executives and their staff. AAOE’s mission is to connect members to the resources necessary to enhance their professionalism, leadership, and skills, and it has a reputation for providing reliable information about service providers in the orthopedic industry.
They found numerous positive recommendations from other orthopedic providers using our services in AAOE’s listserv. Impressed by the glowing reviews, they decided to give Infinx a try.
A Successful Test Run With Infinx’s Patient Access Plus, Prior Authorization Module
The practice decided to start with a 60-day pilot program to test our solution for their surgical authorizations with a limited volume. They were so impressed with the performance of our solution and teams that within a week, they decided to forgo the rest of their trial and convert to an annual contract so we could tackle their entire orthopedic prior authorization volume.
Prior Authorization Processing Gets Back On Track
They began by sending us all their orthopedic and physical therapy prior authorization requests, including epidurals, surgeries, and viscosupplementation. This included codes for TFESIs (CPT 64483, 64484, and 62323), total knee arthroplasty (CPT 27447), total hip arthroplasty (CPT 27130), knee arthroscopy with meniscectomy (CPT 29881), and wrist arthroscopy with carpal tunnel release (CPT 29848), among others.
The practice would upload patient information and clinical documentation to our portal, where our technology and team of experts review and submit prior authorization requests to insurance companies.
Infinx was up and running within a month. Practice staff was relieved and no longer stressed about managing prior authorizations following their colleague’s departure. They were impressed with how easy it was to use our portal and how responsive our team was, with email replies arriving within 15 minutes.
The medical practice was relieved that our team remained up-to-date with any medical policy changes. For instance, if epidurals newly required authorization but this update was missed, up to forty procedures could be done before the error was detected. Our solution helped bridge this gap and improve accuracy.
Quick Implementation And Significant Time Savings For Their Team
Despite not integrating their practice management system with our solution due to cost considerations, they found the process of manually uploading information to our web portal straightforward.
The practice found our platform user-friendly and appreciated the convenience of submitting all information in one place. They find that newly uploaded cases are processed almost immediately without extended wait times.
It now takes them just three minutes to upload the information to our platform, rather than hours spent on payer and TPA websites. The practice checks the portal for status updates regularly and provides additional clinical documents when required. They stay up to date on case approval statuses without phone calls or visits to payer portals.
The implementation of our solution in their workflow resulted in significant time savings. The practice reported a 90% reduction in time spent dealing with insurance companies and making phone calls. They also appreciated our team’s responsiveness and our platform’s ease of use.
In just one month of implementing our solution, the practice saw a decrease in prior authorization denials by 1% and an increase in approvals by 7%.
We also reported that the number of status calls to payers was halved, while the number of automated status checks increased by approximately 43%.
Furthermore, we were able to identify which physicians were contributing to the prior authorization denials due to missing or insufficient clinical documents. This insight allowed the practice to work with those doctors to rectify their clinical document issues, further reducing denials and improving the overall approval rate.
Complete Prior Authorization Coverage Helped Reduced Charge Lag And Increased Claim Payments Downstream
Introducing our solution to provide efficient and accurate prior authorization approvals had a profound impact on the practice. While the front desk staff obviously benefited from the complete support, the workload for their billing department also decreased substantially, allowing them to focus on more critical tasks.
Charges for surgeries were getting done on time, decreasing their charge lag time. They also noted a decrease in claim write-offs and increased claim payments, attributing this improvement to fewer denials due to prior authorization issues, especially for epidurals.
A Raving Review for Infinx’s Prior Authorization Solution
The orthopedic practice was delighted with our solution. They praised the ease of use, our team’s responsiveness, and the significant impact on their operations. They found our solution to be a major relief and highly cost-effective due to the decrease in denials. They also strongly appreciate our customer service. They were particularly impressed by our team’s knowledge of the orthopedic specialty and our ability to effectively communicate what clinical documents are required.
They also provided advice for other practices facing similar challenges who may be nervous about outsourcing prior authorization processing to a vendor.
Continued Partnership and Potential Enhancements
After almost a year of successfully working together, the practice is excited to continue its partnership with Infinx. They plan to send high-volume MRI prior authorizations to our solution for processing and have expressed interest in further customizing their data inputting process.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Are you struggling to find staff to meet your orthopedic practice’s burgeoning prior authorization needs? See how one orthopedic surgery practice leveraged our prior authorization solution to dramatically reduce their prior authorization workload and improve revenue recovery.