“We knew we needed to transform our authorization workflow processes. We were experiencing a high rate of denials due to missing authorizations.”
– Amy Grissett, Senior Director, Ambulatory Revenue Cycle, USA Health
Challenge: Manual processes that couldn’t keep up
Serving more than 250,000 patients each year in hospitals, specialty centers and outpatient clinics, USA Health processes hundreds of thousands of authorizations. Speed is critical. Unfortunately, small inefficiencies were taking a significant toll.
Frustrating manual authorization processes led to errors in the work queue, forcing staff to print schedules multiple times a day to track changes. Inevitably, cases were overlooked, leading to delays and claim denials. It was difficult 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 to handle authorizations, or overworked teams would be under even more pressure. Amy Grissett, senior director of outpatient 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 lack of authorizations.”
Since the hiring of additional personnel had been ruled out, automated prior authorizations They were the obvious solution.
Solution: Authorization automation for faster, more efficient workflows
After working with Experian Health to determine eligibility, USA Health decided to implement Authorizations to optimize your 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 Authorizations You would then track the authorization status, saving time on phone calls and web portals for pending cases. Once authorization is obtained, our product would automatically post the status update to the EHR.”
Automating status inquiries in this way meant that staff no longer needed to search for information through phone calls and payment portals. Dynamic work queues and alerts would guide them towards priority tasks, allowing them to work more efficiently and accurately. Most importantly, authorized services could be authorized without delay.
The tool also compares authorized procedures to those actually performed and flags any variations, so staff can modify claim submissions and avoid denials.
“The implementation process took approximately 6 to 8 months and we did it in phases,” explains Grissett. “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.”
Result: Authorizations increase, denials decrease
Since implementation AuthorizationsUSA 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. Since automated checks on payer websites now offer instant updates for more than half of all accounts, they can focus on a smaller number of complex cases that need hands-on management.
The impact on productivity is clear. With the new workflow implemented, 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 dashboards make it easy 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 make sure 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 due to 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 address missing payer connections and create insight-based rule sets to drive efficiency. As we add new facilities or services, the process is quite seamless. We already have information on the number of staff needed to manage a specific number of accounts, the productivity measures needed, and how to optimize processes. This allows us replicate workflow processes and optimize them. operations effectively. In fact, we have added six more departments with our staff of 28 people.”
– Amy Grissett, Senior Director, Ambulatory Revenue Cycle, USA Health
Looking ahead, the team plans to introduce more service lines and facilities while continuing to refine workflows and optimize processes.
Learn more about how Experian Health automated prior authorizations can help your healthcare organization increase productivity, reduce errors, and avoid costly denials.
