OSS Orthopedic Hospital, LLC (OSS Health) is a leading orthopedic provider in Pennsylvania with an expansive network that includes an orthopedic specialty hospital, multiple urgent care centers, 12 physical therapy clinics, and surgery centers. With over 30 providers and a patient access team of 120 employees, OSS Health handles a high volume of imaging studies, surgical procedures, and pain management cases, all of which require prior authorizations.
As OSS Health grew, so did the complexity of their patient care needs. Managing the rising volume of prior authorizations, particularly for imaging, became a significant challenge when staffing shortages impacted their ability to keep up with demand.
CHALLENGE
OSS Health Struggles to Handle High Authorization Volumes with a Small Team
Over a six-month period, OSS Health lost three key staff members due to competitive recruitment from larger health systems like UPMC. This left their authorization team short-handed while they were handling between 400 and 500 imaging studies each month.
Danelle Newman, Director of Patient Access at OSS Health, described the problem: “We lost three people in six months. There was just no way that we were going to be able to keep up with that volume. I didn’t want our patients to have extended wait periods. With orthopedics and imaging, the results of your imaging study is what really, in most cases, determines, is this going to be a surgical candidate?”
With the staff unable to keep up, Newman knew something had to change. “I needed to look at a solution,” she said. After hearing positive feedback from other healthcare providers, OSS Health decided to explore a partnership with Infinx.
SOLUTION
Partnering with Infinx: A Pilot Program that Led to Long-Term Success
OSS Health began by working with Infinx to handle prior authorizations for imaging procedures. Newman emphasized the flexibility Infinx provided at the outset:
“They said, ‘Give us a shot. We can do a pilot program for you… If you don’t like it and it’s not what you expected, fine, walk away.’”
This low-risk approach allowed OSS Health to test the solution without long-term commitment. Newman saw the value in this offer, noting, “You put a lot of work into figuring out who the right vendor is going to be.”
After the successful pilot, OSS Health expanded Infinx’s role to include authorizations for surgical and pain management procedures. Infinx quickly became an integral part of their workflow. “I really look at them as an extension of my authorization team,” Newman said.
Achieving Seamless Authorization with Human Expertise & Automation
By partnering with Infinx, OSS Health was able to manage the increasing workload without sacrificing control or quality. Infinx took over the bulk of scheduled authorizations, freeing OSS Health’s internal staff to handle urgent cases and cross-train on other responsibilities.
“We were overwhelmed,” Newman explained. “Allowing Infinx to take a large portion of scheduled authorizations gave us the ability to cross-train our internal team. It gave us the autonomy to support different modalities.”
Infinx’s use of automation further streamlined the process, particularly for high-volume, repetitive tasks. Newman noted how automation boosted efficiency: “The AI that they have implemented is 99% accurate. They ping and say, ‘Here’s the member number, here’s the CPTs,’ and it pulls back without humans having to do anything. They get way more done than I would be able to do internally.”
“The quality of the documentation that Infinx provides to us for scheduled authorizations is super important to me. If the insurance is going to deny it, I want to have all the supporting documentation I need to submit an appeal. Infinx does a really good job of their documentation.” — Danelle Newman, Director of Patient Access, OSS Health
A Trusted Partnership and a Scalable Solution for Growth
Newman emphasized that the partnership provided much-needed flexibility for OSS Health as they continued to grow: “If we lose people or need to send more cases to Infinx, they’re ready to step in. We know they can handle whatever volume we throw at them without compromising quality.”
This flexibility has allowed OSS Health to scale their operations while ensuring that authorizations are processed efficiently and accurately, supporting both their internal staff and patient care processes.
OSS Health’s collaboration with Infinx shows how healthcare organizations can overcome staffing challenges and growing workloads without compromising patient care. By integrating Infinx into their team, OSS Health has been able to streamline their authorization process, reduce administrative strain, and improve efficiency. “I don’t ever worry about whether the authorizations are going to get done on time,” Newman concluded. “Between Infinx and my internal team, we’ve got it covered.”
Is your practice struggling with prior authorizations and experiencing depressed revenue recovery? Find how out you can increase monthly collections using Infinx’s RCM & Patient Access solutions here: www.infinx.com/request-a-demo.
Discover how OSS Health overcame staffing shortages and streamlined prior authorizations using Infinx’s automation, improving efficiency and enhancing patient care.