Often seeking treatment due to injuries, physical therapy patients typically want to start with providers as soon as possible. That means prior authorizations must quickly be submitted and turned around. In today’s patient-as-consumer medical marketplace, patients have no trouble finding physical therapy care elsewhere when they can’t be seen quickly.
One growing physical therapy group with dozens of clinics and a volume of 50,000 visits a week faced having to obtain prior authorizations for at least one-third of their patients. In center acquisition mode, the group realized adding staff alone wouldn’t meet their prior authorization caseload.
The network was using another automated solution for benefits verifications but found that the software would frequently leave cases incomplete when it couldn’t find the relevant benefits information. Once again, their patient access teams were saddled with the expensive and time-consuming task of completing benefits checks. It was time for a new approach.
Infinx Offered The Necessary Flexibility
The client evaluated multiple vendors during their decision-making process. Our willingness to design a pilot which included integration with their Raintree EMR to eliminate the need for manual data entry or multiple interfaces was a decisive factor. The client decided to sign on with us for a pilot program of our eligibility and prior authorization solutions at 29 of their clinics.
Infinx, Raintree, and the group’s IT and business workflow representatives came together to develop an implementation plan with buy-in from all parties.
Prior Authorization Errors And Delays Behind High Denials
High denial rates due to prior authorization errors plagued the group. With dozens of locations, they knew centralizing would be key to achieving a cost-effective way to process as many prior auths as possible.
The network had been using another automated solution for benefits verifications. They quickly found that software would frequently leave cases incomplete when it couldn’t find the relevant benefits information. These dead-ends led to patients having to pay the full cost, claims going to write-offs, or providers denying treatment–not an option for this group.
As much as this network strove to provide care, their patient benefits team was saddled with the expensive and time-consuming task of completing benefits checks on top of pressing tasks like getting patients scheduled. It was time for a new approach.
Acquiring New Practices Also Slowed Prior Authorization Workflow
This large physical therapy group was acquiring new member practices at a rapid rate. They had challenges coordinating patient access procedures between clinics, causing a high rate of prior authorization-related denials.
Raintree Integration Eliminates Data Reentry & Multiple Interfaces
With the agreement signed, we jumped into our onboarding process. Due to their high volume of patient access cases, the client opted to have us build an API integration between Raintree and Infinx to allow real-time data transfer in both directions. This meant the client could initiate cases directly through their EMR with no additional time spent re-entering data into our portal. They could also track case progress and view the finalized benefits and prior authorization information directly in their EMR.
Unlike their previous benefits software, our solution provided complete benefit details to ensure more approvals and higher reimbursements. With the combination of our automation and specialists, we were able to alleviate the client’s issues with eligibility and prior authorization-related denials, reducing the burden of appeals on practice staff.
Eligibility And Benefits Solution Provides Complete Patient Financial Clearance
Our patient financial verification uses direct payer integration to provide insurance eligibility checks and benefits information in real-time. When a payer can’t be accessed electronically, our agents call and verify insurance details.
This ensures that benefits checks are never returned blank or partially complete, unlike their previous automation-only software, and saves them hours on the phone with insurance companies or on payer portals.
Efficient Prior Authorization Workflow Enables Faster Onboarding
Once benefit details became available and the relevant prior authorization details were uploaded into the client system, our machine learning-based authorization determination engine analyzed cases.
If authorization was needed, our solution initiated it with the payer. Our operations agents performed regular status checks and stepped in to handle complex cases. When a peer review or additional clinical information was requested, we alerted the client. When the authorization was approved, details appeared on the client’s EMR.
Standardization Reduces Manual Workload By 70%
Implementing our automated insurance eligibility, benefits, and prior authorizations has created a major impact, ensuring the client’s patient access needs get taken care of in a cost-effective manner as they continue to expand.
Today, their new automated prior authorization workflow is significantly easier to use. Standardization across all 29 clinic locations enabled a 70% reduction in their manual workload. Standardization has also enabled the group to manage costs and easily train or onboard new hires to keep up with their prior authorization needs.
Standardizations Eases New Practice Onboarding
When the client acquires a new clinic, they’re able to streamline patient access by using our product as a central system. Onboarding new employees from the new acquisitions is far easier as the prior authorization workflow is straightforward and standardized. The hurdles of coordinating patient access workflows between dozens of different clinics have been significantly reduced.
Initial Success Leads To 300-Clinic Implementation Plan
After a successful pilot at 29 of their clinics, the client decided to add 30 more clinics to our systems with a plan to implement another 300 in the future.
We’ve had a very positive experience working with you and your team so far…we appreciate their attention to detail and willingness to take feedback!
—Senior Director of Revenue Cycle
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Are you seeing eligibility or prior authorization-related denials? See how a major physical therapy group was able to get theirs under control and dramatically increase patient volumes.