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Brandon McCordOchsner Health System
Martha Mancino Co-PresenterExperian Health
Introducing:
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Innovate your Auths
The path toward a streamlined Authorization Process
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Centralized Pre Authorization team supporting 20 Health Centers and over 60 clinic locations
► Revenue Cycle based department located in New Orleans, Louisiana
► Team currently made up of 102 FTEs, 15 of which are RNs and LPNs
Team Breakout
► Surgery, Radiology, Clinic, and Clinical Review Team
► Process levels are broken out around efficiencies
Who we are
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Continuous volume growth in the past 3 years
More demanding payor requirements
Greater shift towards patient responsibility
“Do more with Less”
Needed to streamline the process and eliminate non-value added touches
Why Innovate?
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Lean auth process that make teams more efficient
► Use Lean mentality to evaluate workflows
► Focus the team on Value adding actions
Make sure the tool fit our workflow (Why we chose to integrate within Epic?)
► Patient receives a call related to financial liability once service is approved
► Any tool must work with our Epic workflow
Tool needed to make a positive impact on the team
Why did we start with Surgery?
► Build Implications
► Early Big Impact
Desired Outcomes & Considerations
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Partner with Experian Health for Automated Authorization Inquiry
Continuous auth check with notated results
Built directly into Epic
► One button drives the process
Helps our team focus on Value added touches
Allows us to clear cases faster and provide communication to the patient
What we did - Real Time Passport Authorizations
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Procedure is scheduled prior to falling to the proper Pre Service Epic work queue
IV, Benefits and Auth Submission
► Auth submission is not automatic
Users fill in any necessary fields, including referring and referred-to department information
► If CPT or related information missing, this must be completed prior to RTA
Hit the button to start the Experian “Inquiry” process
New Process through RTA
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Who we are
Pre-workflow
Case submitted with authorization request to payor
• Follow-up, follow-up, follow-up….
• Countless Non-value added touches
Limited number of cases a rep could touch
• Negatively impacted lead days
Post-workflow
Submit and send 278 through Epic to start RTA ping process
• Staff is able to “Set it and forget it”
• RTA notates the referral in Epic for each “ping”
• Workflow allows for escalation and manual follow-up if case is not approved by a specific day
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Pre-Service users then check the External electronic authorization checkbox in the referral on the Authorizations form.
Real Time Auth Workflow
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Notification History form was added
This is where we track RTA productivity
Auth/Certs Notification Event for RTA
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“Ping” or Inquiry History
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Authorized
► Case automatically moves from Auth work queues to Financial work queues
● Referral Status is updated to authorized
● Note placed in referral related to auth
● Payor Screen scraped for follow up if needed
► Patient is communicated about expected liability and able to make a payment
● Auto Dialer phone call
● “My Ochsner” patient portal
● Patient is able to work with a Financial Coordinator if needed
RTA Process Moves on
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Example RTA Authorized Note
Speaker intro or subhead goes here
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Denied, Needs Additional Information, Peer to Peer, ect.
► Case falls automatically to a follow up WQ
● This is driven by the ANSI code received back from the payor through Experian
● Status is automatically changed on the referral to (RTA Follow Up)
► Manual intervention by Team
● Identify Response
● Contact Payor
● Notify Ordering Physician
What if it not Authorized
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Increased Productivity
► Positive impact on Surgery, Radiology and Clinic lead days
Reallocation of 10 full time employees to different authorization teams
► Allowed us to add service lines, bolster other auth teams, enhance financial estimation team
User Feedback and Impact
Now we are Live with Surgery, Radiology, and some office procedures
Rollout from Here
► New Locations & Service Areas
► Enhance our Redesign
Project Impacts
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Determine if this workflow is ideal for your organization
Evaluate current workflow and how RTA will impact this
► Impacts to auth prior to scheduling, ect.
Discuss frequency of ‘ping’ attempts with vendor, and if this suits your needs
Discuss which insurance plans will be a good fit for RTA
► If they lack online auth capability, it will not work
Should messages be sent manually or automated?
Things to Consider
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Get on the same page with everyone at time of build!
Work on payor log-ins early
► Anything new takes time
Obtain the team’s buy in
► New Workflows may are scary
Test, monitor, monitor
► Each location, payor, and service line
Plan a flexible Roll Out
Lessons Learned
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Thank you &
Any Questions?