Speech Therapy Group Uses Prior Authorization Solution To Speed Scheduling And Reduce Denials

A recent American Medical Association study reveals that 88% of all physicians characterize the prior authorization burden as “high” or “extremely high.” Over 90% report that prior authorization hassles lead to delays in care, and 33% report that these delays have led to a serious adverse event for at least one patient.

Prior authorizations are a particularly sensitive matter for pediatric speech and language therapists because they know the earlier their patients start therapy, the better their outcomes. For a child undergoing rapid development, waiting even a few months can diminish long-term results.

Further, focused on providing care, speech therapists and staff can’t always stay current on payers’ guidelines. Given they’re dealing with a dozen or more insurance companies that change guidelines every quarter, it’s no wonder prior authorization errors and missed deadlines abound.

One pediatric therapy group specializing in speech and language services found excessive prior authorization denials not only delayed care and frustrated patients, but stifled their revenues. This six-location Colorado group employs 29 therapists consisting of 19 speech and language pathologists, eight physical therapists, and two occupational therapists. Working closely with the family, these specialists create individualized plans for children up to age 18.

Staffing Issues Cause Prior Authorization Errors & Delays

Like most healthcare providers, this group couldn’t find sufficient staff to get their prior authorizations completed on time and accurately. Delayed patient scheduling frustrated parents and diminished patient volume. Further, incomplete and inaccurate authorizations triggered denials which spiraled into more delays. All of these factors curtailed group revenues. Given that this group had set its sites on other locations to acquire, they knew they needed to find a way to improve their prior authorization turnaround time and accuracy.

An Integration-Free Prior Authorization Solution Chosen

The group started their exploration by asking their EMR vendor the price for integrating an automated prior authorization solution with their current system. The vendor quoted $15,000 to $20,000 just for the integration, a figure out of reach for a small business. The group owner passed on that option.The group then evaluated several vendors to find a solution that didn’t involve an integration. When we explained that we could provide prior authorization support via manual uploads, they chose our solution.

Expert Oversight For Prior Authorization Uploads

When we began working with this client in July 2021, they manually uploaded prior authorizations one by one. Without the integration, they couldn’t take advantage of automation which would check for prior authorization necessity and step staff through including complete documentation and up-to-date coding.The automation feature of our solution monitors the progress of prior authorizations through the payer’s system. It also updates providers promptly if any requests come through.With our Patient Access Plus solution, should a complex authorization fall outside the scope of the automation, our trained and certified specialists take over, resolving payer requests and facilitating communication between payer and provider. Our two-pronged automation + specialists approach ensures all providers’ prior authorizations get completely serviced.Given the integration expense, however, this client chose only specialist oversight. For one year, staff uploaded a limited amount of prior authorizations one by one, each day.Our specialists review them, cross-referencing them with the most current payer guidelines. We help secure authorization for common speech therapy procedures like:

• Treatment of speech, language, voice, communication, and/or hearing processing disorder (92507)
• Evaluation of speech sound production with evaluation of language comprehension and expression (92523)
• Treatment of swallowing and/or oral feeding function (92526)
• Therapeutic procedure to re-educate brain-to-nerve-to-muscle function (97112)
• Therapeutic activities to improve function, with one-on-one contact between patient and provider (97530)…and many more.

Should our specialists find missing documentation or errors in documentation or coding, we make sure they are rectified before sending the authorization to the payer. Catching mistakes before submission avoids denials and time-consuming resubmissions. Our customer success manager checks in with the group’s senior full-cycle supervisor once each month and on an as-needed basis. They discuss any challenges, changes .in workflows or payer protocols, and any trends either the group sees or we see from our end. Client services is always available and ready to research any inquiry from the speech therapy group.

Prior Authorization Solution Settles Staffing & Denials Crisis

Using a third-party partner solved several of this group’s revenue issues. We provided the staff to handle not only their current prior authorizations but those additional ones coming from the new locations. The quicker prior authorization turnaround we brought sped scheduling, ramping up patient volume. Fast scheduling increased patient satisfaction as well. Parents want their children’s issues addressed as quickly as possible after all.

The smooth transition we enabled helped the group build a solid reputation as they got a foothold in their new communities. Further, a boost in authorization accuracy, completeness, and on-time submissions dropped this group’s denials rates, leading to higher revenues.

Bulk Upload Speeds Prior Authorization Turnaround Time

Within a year, these successes prompted the group to quadruple the number of prior authorizations apportioned to us. Given the larger volume and lack of integration, we suggested that, rather than submitting prior authorizations one by one, they consider a bulk upload where staff enter selected patient records from their EMR. We created a custom spreadsheet for this client and received this bulk upload with no issues. As with the first authorizations, we began working on these prior authorizations immediately. Currently, this client is very pleased with our work.

If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.