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Brandon McCordOchsner Health System

Martha Mancino Co-PresenterExperian Health

Introducing:

©2016 Experian Information Solutions, Inc. All rights reserved. Experian Public.

Innovate your Auths

The path toward a streamlined Authorization Process


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


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?


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


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


Process Overview


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


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


Pre-Service users then check the External electronic authorization checkbox in the referral on the Authorizations form.

Real Time Auth Workflow


Notification History form was added

This is where we track RTA productivity

Auth/Certs Notification Event for RTA


Process Overview


“Ping” or Inquiry History


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


Example RTA Authorized Note

Speaker intro or subhead goes here


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


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


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


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


Thank you &

Any Questions?

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