CASE STUDY

Growing Physical Therapy Group Resolves Prior Authorization Bottleneck Using Automation

Growing Physical Therapy Group Resolves Prior Authorization Bottleneck Using Automation

For large physical therapy groups, securing accurate prior authorizations and benefit checks on time is critical for quality patient experience and financial health.

The client is a large network offering physical, occupational, and speech therapy services in 270 locations across the East Coast and Midwest. Established in 2003, they treat a wide variety of conditions including chronic pain, sports injuries, post-cancer rehabilitation, and lymphedema. They have a number of clinics specializing in pediatric services and provide telehealth offerings.

High Denials Stemming From Prior Authorization Delays And Incomplete Benefits Verifications

With a volume of 50,000 visits weekly and at least one-third of those requiring authorizations, this rapidly growing network realized that adding staff alone wasn’t going to be a financially sustainable solution for their patient access needs. Acquiring new practices at a rapid rate, this large PT group found the increased volume of prior authorizations and eligibility verifications expensive. They also struggled to coordinate prior authorization processes between clinics, causing a high rate of related denials.

The network’s many locations made standardizing a prior authorization workflow a challenge. A standard process would most efficiently train and onboard new staff. Additionally, frequent prior authorization errors were leading to high denial rates.

Where prior authorizations were handled in house, benefits verifications were done through an automated solution. Unfortunately, this software frequently left cases incomplete when it couldn’t find the relevant information. Once again, their patient access teams were saddled with the expensive and time-consuming task of completing benefits checks. It was time for a new approach.

Infinx Streamlines Benefits Verifications And Prior Authorization Workflow For 29 Locations

Struggling to improve revenue with their current system, the network sought a cost-effective solution for improving prior authorization and completing benefits verifications. The client evaluated multiple vendors during their decision-making process.

Infinx and Raintree—the network’s EMR platform—along with the network’s IT and business workflow representatives came together to develop an implementation plan with buy-in from all parties.

Our willingness to design a pilot which included a Raintree integration that would eliminate manual data entry was the deciding factor for them. The client signed on with us for a pilot program of our eligibility and prior authorization solutions at 29 of their clinics.

Custom Raintree Integration Eliminates Need For Data Reentry And Multiple Interfaces

Due to their high volume of patient access cases, the client opted to have us build an API integration between Raintree and Infinx to allow real-time data transfer in both directions. The client can initiate cases directly through their EMR with no additional time spent re-entering data into our portal or switching back and forth between different screens. They could also track case progress and view the finalized benefits and prior authorization information directly in their EMR.

Eligibility And Benefits Solution Provides Complete Patient Financial Clearance

Our patient financial verification uses direct payer integration to provide eligibility checks and benefits information in real-time. When a payer can’t be accessed electronically, our agents call and verify insurance details. This backup ensures that benefits checks are never returned blank or partially complete, unlike their previous automation-only software.

Efficient Prior Authorization Workflow Enables Faster Onboarding

Once benefit details are available and the relevant prior authorization details are in the client system, our machine-learning-based authorization determination engine analyzes cases.

If an authorization is needed, our solution initiates it with a payer. Because our operations agents perform regular status checks, they step in to handle complex cases promptly. When payers request a peer review or additional clinical information, we alert the network. Once an authorization is approved, details are displayed directly on the network’s EMR.

Network Improves Revenue And Onboarding With A 70% Decrease In Workload

Implementing our solutions has had a major impact. The 70% reduction in their prior authorization workload has saved the network an estimated $766,000 per year.

Adding the reduction in denials, rework, and write-offs, the projected return on their investment in our prior authorization solution is over $1,000,000.

The network reports that their new automated prior authorization workflow has eased patient access among the participating sites. Practice staff are able to focus on patient care and see a larger volume of patients.

Furthermore, standardization across all 29 clinic locations has also enabled it to easily train and onboard new hires while keeping up with prior authorization needs. Expansion, too, has become more streamlined. Doing patient access processes through a central system has made it easier to integrate new practices into the group.

Additionally, unlike their previous software, our eligibility and benefits solution always provides complete benefit details, reducing revenue leakage.

After a successful pilot at 29 of their clinics, the client decided to add 30 more clinics to our systems with a plan to implement another 300 in the future. Our prior authorization and eligibility solutions have created a major impact, ensuring their patient access needs will be taken care of in a cost-effective manner as they continue to expand.

Could your physical therapy group benefit from an automated patient access solution to reduce costs and support growth?

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