An east coast medical imaging center with one of the most successful outpatient radiology practices in the United States struggled to keep up with prior authorizations. It is one of the largest single-center imaging centers in the area and offers three MRIs. They specialize in providing full major modality scans, specifically CT, PET, MRI, and nuclear medicine.
Overwhelming Volume of Prior Authorization Demands
Roughly 70% of the group’s referring providers asked the radiology group to obtain the necessary prior authorizations from the payers directly. Certain payers were allowing imaging centers to start the authorization process, but not complete it. Other payers wouldn’t allow imaging centers to process the prior authorizations at all.
Unfortunately, the client was watching as their competitors sidestepped these rules and continued to process the authorizations themselves. Thousands of dollars per week in patient revenue were at risk. The imaging center needed a way to follow the rules while also remaining competitive.
Additionally, about 30% of the client’s daily patients needed expedited authorizations. Acquiring the necessary approvals from the insurance companies via phone could take up to an hour per authorization—a logistical nightmare for the small authorizations team in place. The client could not counter the rise in volume by simply hiring additional staff. If they wanted to retain patients and also maintain good working relationships with the referring physicians, they needed a solution that could receive authorizations quickly and accurately.
A Prior Authorization Solution Built to Scale
With a high-volume of prior authorizations and a small staff, the imaging group prioritized a solution that could offer total automation of the prior authorization workflow. The interface would need to be easy for their staff to learn and provide cloud-based access so that it could be accessed by any computer. They also needed a legitimate way—payer approved— to process authorizations. Our solution was the answer.
The proprietary prior authorization software for imaging centers evaluated each procedure to determine if prior authorization was required. The software then initiated the cases electronically that did require authorization from the specific payer or benefits manager. Once a case was initiated, the software provided the radiology group with an authorization reference number and continuously followed up with payers by using automation that provided real-time updates and notifications.
Integration With Client’s RIS For Ease-Of-Use
The solution was completely integrated with the client’s RIS system. Integration allowed the provider to work within their system and not have to log into another web-based system to submit their prior authorization requests. The resulting low maintenance and low touch experience for the customer saved staff a lot of time and effort in manually entering case information into a web portal.
At full utilization, our prior authorization software provides an unprecedented ability to scale as authorization volumes increase and when a network expands to include new geographies.
In addition, our prior authorization specialists were available to manually handle any request, in the event of a complex scenario or if the payer did not support electronic submissions.
Prior Authorization Solution Levels the Playing Field Within 2 Months
It only took four weeks to go live and two months to see results, a pace that leveled the playing field with their competition.
By utilizing our prior authorization software, the radiology group has realized tangible benefits including:
- Reduced insurance verification and benefits processing time
- Diminished need for more staff
- Faster turnaround times for patient authorizations and scheduling
- Significantly reduced manual and burdensome administrative tasks
- Strengthened relationships with referring physicians and medical practices
Future Forecast
Today, we process 200+ imaging scans per month for this radiology group. Within a year’s time they anticipate the number of prior authorizations increasing significantly to as many as 800 to 1,000 imaging scans per month.
The group is now poised and excited to deploy the full utilization of our prior authorization software, which includes the proprietary Authorization Determination Engine—a rules-based engine that leverages machine learning to authorize requirements in real-time and optimizes the radiology group’s workflow and patient retention efforts. With full utilization of the prior authorization software, the group believes it will be able to handle the increased volume efficiently and effectively.
Have you implemented smart technology like artificial intelligence and robotic process automation in your patient access workflow yet? See how an East Coast imaging center increased revenue by equipping their team with our AI-powered Prior Authorization solution.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Have you implemented smart technology like artificial intelligence and automation in your patient access workflow yet? See how
an east coast imaging center increased revenue by equipping their team with our AI-powered Prior Authorization solution.