Patient access has become an administrative burden for all orthopedic practices, creating a negative patient experience. Before a patient is seen, orthopedic practices need to verify the patient’s insurance coverage, identify out-of-pocket costs, determine if prior authorization is required, and initiate authorization requests. Any follow-up on prior authorization approvals also needs to be performed. Failure to do so results in denials and uncollectable services from payers, negatively impacting the financial bottom-line.

From a financial impact, the patient access process negatively impacts patients. The average cost for manual verification for insurance eligibility is $8.64 and for prior authorization is $9.64, per the latest 2021 CAQH Index. Patient access teams spend hours each day on the phone and payer portals to verify benefits and get authorizations. Often, it isn’t until the claim is denied (up to 60 days post-visit) that a problem is discovered that must be reworked and resubmitted.

Infinx’s Patient Access Platform allows for a single, comprehensive financial clearance center that verifies eligibility, retrieves benefit coverage, and provides out-of-pocket patient pay estimates that can be collected at the point of service for orthopedic practices. Additionally, by leveraging artificial intelligence (AI), payer, and clearinghouse automation combined with our Patient Access Specialists, the platform intelligently evaluates prior authorization requirements and electronically initiates the cases to the payer for required services and performs constant follow-up to get approval, providing a complete end-to-end workflow solution.

By leveraging advanced technologies using AI and robotic process automation (RPA) for patient access, the burdensome administrative workflow is streamlined, allowing you to collect more revenue while increasing patient satisfaction.

Learning Objectives

  • How RPA and AI positively impact the patient access workflow in the orthopedic industry
  • How AI is made actionable in a patient access solution
  • How AI impacts patient satisfaction through faster prior authorization turnaround times
  • How augmented intelligence eliminates the hassles of manual staffing efforts to improve the patient experience while reducing overall administrative costs

About Paul Marin

Paul Marin serves as the Director of Business Development for Infinx in the West region, where he leads new business and strategic growth opportunities. He has a deep understanding of Revenue Cycle workflows as well as EDI operations.

Over the past 12 years of he has held positions with industry leading technology companies both large and small, solving revenue cycle challenges. He also has experience in the Orthopedic and Spinal implant distribution segments of the market. He holds a Bachelor of Science in Management from University of Phoenix, as well as a Master of Administration in Leadership from Northern Arizona University.