“We knew we needed to transform our authorization workflow processes. We were experiencing a high rate of denials due to a lack of authorizations.”
– Amy Grissett, Senior Director of Ambulatory Revenue Cycle at USA Health
Challenge: Manual processes that couldn’t keep up
Serving more than 250,000 patients each year across hospitals, specialty centers and outpatient clinics means USA Health processes hundreds of thousands of authorizations. Speed is critical. Unfortunately, small inefficiencies were taking a major toll.
Frustrating manual authorization processes resulted in work queue errors, forcing staff to print schedules multiple times a day to keep track of changes. Inevitably, cases were missed, resulting in claim denials and delays. It was hard to see where to make improvements without a reliable way to monitor staff performance.
As new service lines were added and authorization requests grew, USA Health needed to find a more efficient way of handling authorizations, or overworked teams would be under even more pressure. Amy Grissett, Senior Director of Ambulatory Revenue Cycle at USA Health, says, “We knew we needed to transform our authorization workflow processes. We were experiencing a high rate of denials due to a lack of authorizations.”
Since hiring extra staff had been ruled out, automated prior authorizations were the obvious solution.
Solution: Automating authorizations for faster, more efficient workflows
Having already worked with Experian Health for eligibility, USA Health decided to implement Authorizations to optimize their workflows and automation. Alicia Pickett, Senior Product Manager at Experian Health, explains how this partnership worked:
“First, the team needed to determine if authorization was necessary. If so, they would complete the authorization on the payer’s website. Experian Health’s Authorizations would then track the status of the authorization, saving time on phone calls and web portals for pending cases. Once the authorization was obtained, our product would automatically post the status update into the EHR.”
Automating status inquiries this way meant staff no longer needed to chase information through phone calls and payer portals. Dynamic work queues and alerts would guide them to priority tasks, allowing them to work more efficiently and accurately. Most importantly, authorized services could be cleared without delay.
The tool also compares authorized procedures to those actually performed and flags any variance, so staff can amend claims submissions and prevent denials.
“The implementation process took approximately 6-8 months, and we did it in phases,” Grissett explains. “We started with one service line. As the team became more comfortable, we added additional service lines. Overall, the implementation met our expectations. And the solution has greatly improved our authorizations process and workflows.”
Outcome: Authorizations up, denials down
Since implementing Authorizations, USA Health has seen measurable improvements, including:
- Increased daily authorizations by 100%
- Cut manual work by 50% and reduced errors and denials
- Expanded to six service lines without increasing staff
- Provided accurate tracking of staff productivity
Instead of relying on slow, manual processes, staff now have thirty dynamic work queues at their fingertips, helping them process 130,000 authorization requests each year. Thirty dynamic work queues organize tasks by date and service line in real time. With automated payer website checks now delivering instant updates for more than half of all accounts, they can focus on the smaller number of complex cases that need hands-on management.
The impact on productivity is clear. With the new workflow in place, the average number of accounts completed per employee each day has more than doubled, from around 20 accounts to between 40 and 50.
In addition to monitoring accuracy and denial rates, Authorizations’ monthly scorecards make it easier to measure staff performance. Grissett says, “We were trying to do more with less. We also wanted to be able to monitor what our employees were doing and ensure they were accountable. The tools that Experian provides allow us to capture that data.”
All of this benefits patients, too: With automated prior authorizations, fewer appointments are canceled or rescheduled because of authorization delays, so patients don’t have to wait for care.
“The Experian team was instrumental in helping us pivot and develop specific workflows tailored to our needs. Together, we addressed missing payer connections and created knowledge-based rule sets to drive efficiencies. As we add new facilities or services, the process is fairly seamless. We already have the intel on the number of staff required to manage a specific number of accounts, the productivity measures needed and how to streamline processes. This allows us to replicate workflow processes and optimize operations effectively. In fact, we’ve added six more departments with our staff of 28.”
– Amy Grissett, Senior Director of Ambulatory Revenue Cycle at USA Health
Looking ahead, the team plans to introduce more service lines and facilities while continuing to refine workflows and streamline processes.
Find out more about how Experian Health’s automated prior authorizations can help your healthcare organization boost productivity, reduce errors and prevent costly denials.
