Eliminated Costly Preauthorization Delays at Top U.S. Hospital

THE BACKGROUND One of the largest and most respected hospitals in the country contacted Infinx after they had run into problems with a patient access vendor in South America. The […]

By Infinx
October 18, 2018
05:47 pm

THE BACKGROUND

One of the largest and most respected hospitals in the country contacted Infinx after they had run into problems with a patient access vendor in South America. The hospital was perpetually backlogged. It had to reschedule and turn patients away resulting in lost revenue and underutilized equipment. Overwhelmed and frustrated by costly payor delays and denials, the hospital sought a new, definitive solution to chronic preauthorization process inefficiencies and administrative issues, which had been adversely affecting both its patients and physicians for years. They needed a solution that could bring efficiency to the hospital’s utilization management while improving patient satisfaction and revenue.

Processing preauthorization requirements is complicated and labor intensive. As the only solution in the market that leverages both artificial intelligence (AI) and human intelligence (HI), Infinx guaranteed the hospital that its Patient Access solution would authorize every procedure before the appointment occurred, eliminating time-consuming efforts to chase down money after the fact. Additionally, Infinx offered unbeatable price points and experience migrating data from existing, problematic vendors.

THE TECHNOLOGY

Our Infinx Patient Access Software solution helped the hospital get ahead of the revenue cycle problem by quickly authorizing and confirming that every procedure rendered could be billed with near certainty to its accuracy and propensity to collect. The solution is built on Infinx’s proprietary technology platform, iBridge, which uses AI to automates repeated tasks with workflow optimizations. Exceptions are handled by preauthorization and billing specialists.

Thanks to seamless integration with the hospital’s existing EMR software, the platform was deployed with little disruption to the hospital’s day-to-day operations. We guaranteed strong IT security standards and the overall satisfaction of the hospital’s complex structure of internal stakeholders. Infinx also provided the flexibility of its team of healthcare preauthorization specialists when cases of exception processing required a manual touch.

PLANNING & IMPLEMENTATION

Our team mapped the hospital’s process and aligned its own process to create a best practice workflow. Next, we studied the hospital’s specific payor nuances and the hospital’s policies of how to handle payor questions Then, we examined the clinic’s workflow for obtaining additional information for a patient. Once the implementation had been completed, we provided world-class customer support to handle issues, upgrades and maintenance.

The Results

99.5% ACCURACY & TOTAL TRANSPARENCY = PEACE OF MIND

  • Overall > 95% successful authorization rate
  • 100% SLA compliance to STATs, same day and standard appointments
  • >99% error-free audits on all documentation
  • 100% compliance to all payor guidelines, protocols
  • More than 1,000+ preauthorizations completed daily
  • 100% compliance to HIPAA standards.

“Infinx dramatically improved our preauthorization process. Our backlog was taken care of immediately, and we saw a substantial improvement in the number of preauthorizations completed on-time.” Client

OPTIMIZED FOR SCALE WITH RAPID TAT AND IMPECCABLE ACCURACY

  • Designed for Scale: Infinx conducted 84,000 preauthorizations in six months. During this time, the preauthorization count nearly doubled from 9,500 to 17,500 preauthorizations per month.
  • Impeccably Accurate: Infinx conducted 20,152 audits over sit months on the preauthorizations performed to measure the accuracy of the solution, and maintained a 99.5% rate of accuracy.
  • Continually Optimized: Infinx’s quality group conducted audits that allowed our client to track the agreed upon metrics so that our process continued to optimize.
  • Rapid TAT and STAT: For standard jobs, next day and forward, Infinx initiated the request with the payers within 24 hours. For same day jobs, appointments of same day minimum four hours out, Infinx obtained a final determination within four hours. For STAT jobs, appointments within four hours of receipt, Infinx obtained a final determination within 30 minutes.

CONFIDENTIAL, SECURE, HIPAA COMPLIANT & MEDICALLY NECESSARY
It is standard practice for Infinx to maintain full HIPAA compliance, in both technical security and handling of patient information (PHI). Such standards have been a hallmark of Intelligent Patient Assist, iBridge and our preauthorization team:

  • Fully Encrypted: All PHI stored via iBridge were fully encrypted, per HIPAA guidelines, and stored on Amazon Web Services S3 cloud servers, at secured locations, providing SOC2 compliance documentation.
  • Completely Secure: Patient data was never stored longer than necessary, with regular archiving and purging. All files were password-protected and access-controlled, as necessary.
  • HIPAA Compliant: Preauthorization team members were proficient in HIPAA-compliant standards and protocols, via formal training and periodic reviews. Medical necessity was always observed and followed.
  • Regularly Audited: New software updates were thoroughly reviewed and tested for airtight data security, while all technical infrastructure and procedures were regularly audited throughout the year.
  • Private and Confidential: The customer’s privacy and confidentiality was 100 percent assured. Industry standard intrusion detection, up to date firewalls. In addition, Infinx Implemented all HIPAA standards and regulations.
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Eliminated Costly Preauthorization Delays at Top U.S. Hospital

One of the largest and most respected hospitals in the country contacted Infinx after they had run into problems with a patient
access vendor in South America.

About the Author

Infinx

Infinx

Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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