Short-Staffed Connecticut Orthopedic Practice Resolves Aging A/R On A Deadline With Partner

The practice initially partnered with us two years ago seeking a more efficient alternative to their time-consuming manual prior authorizations. Since then, we’ve used our AI-powered solution to obtain prior authorizations for spine and viscosupplementation procedures at multiple locations.

Recently, they were facing a staffing challenge in both their patient access and A/R teams due to resignations and staff health challenges.

As a result, the practice had a data entry backlog problem for their prior authorizations, which they had been entering manually into our automated solution. They were also struggling with aging A/R which needed to be worked before the timely filing limit.

Due to our ongoing success with supporting the orthopedic office’s prior authorizations, they relied on our team to provide support while being short-staffed. They trusted our partnership with their in-house billing and patient access systems.

They engaged our team to provide data entry services for three separate types of prior authorizations and work down their outstanding A/R inventory.

Our specialists were able to login to the practice’s EMR (GE Centricity) to enter information into our automated prior authorization solution. They use a secure, SOC-2 certified connection to keep data safe from cybersecurity risks. Our operations agents are trained to use the same workflow as in-office staff, which helped keep things running smoothly.

We provided data entry services for epidurals, viscosupplementation, and surgical prior authorizations, which in combination with our existing automated solution, keeping their patient access process on track.

After patient data is entered into our prior authorization system’s web portal, our AI determination engine consults its database of payer rules to determine with 98+% accuracy when an authorization is needed. This saves practice staff the hassle of spending hours on the phone or payer websites.

Our specialists then follow up with the payer until an authorization is obtained, only alerting practice staff when additional clinical information or a peer review is requested. Once patient data is in the client system, our specialists and automated solution handle the rest. Practice staff can simply check our online portal to see when an authorization is complete and focus on higher-value tasks.

The dashboard on the left displays case information, along with the status of prior authorization claims.

Our A/R recovery specialists assisted with working through the outstanding A/R that had accumulated due to their shortage of billing staff. Our specialists can work through 70% of the A/R inventory on average with no further involvement from the practice staff and require more information on about 30% of claims.

We’ve been able to reduce the percentage of aging A/R within 3 months and highlight revenue cycle trends and issues to help generate additional cash flow. These included challenges in patient collection, coding issues, payment reconciliation from the old A/R, and prioritizing work based on filing limits.

With the additional support from our patient access specialists and software, the practice could rest easy, knowing prior authorizations would arrive on time despite their staffing shortage. They trust our team to work directly in their EMR to support data entry and, after two years of successful authorizations, they know they can count on our automated solution.

They are pleased with our delivery of A/R recovery services and have opted to work with us on an ongoing basis, handling A/R end-to-end for aging reduction, enhancing cash flow, and ensuring timely follow up of claims.

When the practice’s new CEO and executive team asked how the practice had been able to pull through the pandemic despite being short-staffed, they said that Infinx had been able to help them during a time of need.

Currently, the practice is in talks to learn more about our AI-powered A/R optimization technology solution and plans to complete an electronic integration between our systems to eliminate the need for manual data entry in the future.