The rising complexity of cancer treatment along with the variety of emerging targeted treatments has made prior authorizations an increasing burden to oncology clinics. Moreover, prior authorizations for oncology may require a significant amount of documentation, like chemotherapy injection sites, frequency, and cycles of service.
With nearly universal staff shortages, the hefty time burden of prior authorizations can delay and compromise patient care and take a major chunk out of clinic bottom lines. Streamlining this process has become vital, and with the significant cost of cancer drugs, oncology providers need to know their services will be covered.
Backlogged Prior Authorizations Causing Delayed Treatment Amid Staff Shortage
Our client, an oncology group with four locations across Oregon, found it nearly impossible to stay on top of their prior authorization workload. A physician-owned practice, they have been in business for over forty years specializing in all aspects of cancer treatment, specifically chemotherapy, immunotherapy, hematology, and medication dispensing, amongst many other oncology subspecialties.
They employ nine physicians as well as ten advanced practice providers and provide lab and imaging services in addition to cancer treatment. Due to a staffing shortage, they found that their two remaining in-house patient access staff were overwhelmed by their large volume of chemotherapy, imaging, and lab prior authorizations.
Infinx’s Solution Chosen To Automate Prior Authorizations
They decided to find a partner to augment their team who could attend to the details of oncology prior authorizations. They compared proposals from multiple vendors. Our willingness to adapt to their specific needs and significantly reduce their workload satisfied their needs for a partnership. The group decided to sign on for a pilot of our automated prior authorization solution along with additional support for data entry. They also hired two of our patient access experts to do EMR system data entry to aid with their prior authorization workflows.
They hit many roadblocks when searching for prior authorization specialists with oncology domain knowledge in the surrounding area and at an affordable price.
Our offering of easily accessible and costeffective remote specialists aligned with their trajectory. Shortly, the practice built a harmonious relationship with our prior authorization team and was able to quickly adapt their workflow to the addition of our web portal.
Prior Authorization Workloads With Robotic Process Automation, AI, And Domain Expertise Specialists
Working closely with our client, our data entry specialists learned to pull patient information, CPT codes, appointment information, and other appropriate clinical documentation from their EMR. Our AI engine then handled the next step, determining if authorization is necessary with its national, regional, and local payer database. Our solution then automatically submits claims with the required provider details, patient demographic information, as well as any essential tests and diagnostic documentation.
We perform frequent status checks and updates keeping practice staff informed on claim approval statuses. For more complex claims, our expert specialists intervene when possible, reducing the need for practice staff to be involved. When authorizations are approved, that information is available readily on the portal.
Organized Prior Authorization Process Enhances Workplace System
Providing our client with an easy-to-use interface helped to strengthen other areas of their workflow. While manual prior authorization processes can often be disorderly, our dashboard offers an overview of all claims and their progress in one place. In a few easy clicks, our clients could monitor a claim from requirement necessity, submission, and follow-ups.
Analytics Help Improve Documentation And Reduce Denials
Our prior authorization solution’s machine learning-based analytics module helped produce insight into which prior authorization claims were being denied and why. With this information, our operations team was able to work with the physicians to further improve provider notetaking. This helped improve outthe-door claim approvals, turnaround times, and timely reimbursements.
Staffing Challenges Resolved: 70% Decrease In Prior Authorization Workload And Improved Approval Rates
A combination of our automated solutions and data entry specialists were able to create a streamlined prior authorization process, reducing the group’s manual prior authorization workload by 70% and achieving a near zero rate of denials.
They appreciated the consistent support, ease-of-use, and willingness to communicate with them about the operational improvements we recognized through analyzing submissions.
With shorter turnaround times and a denials decrease, their staff can keep prior authorizations on track and provide a better patient experience. The clinic’s patient access process is no longer negatively impacted by their staffing shortages and they can focus on providing excellent patient care.