Urology Practice Case study

Digital overhaul yields 15 day prior authorization improvement for a premier urology network

$100 M

Prior authorization required

126

Locations

32

Ambulatory Surgery Centers

About

A leading medical group stands as a premier national network of urology specialists, boasting affiliate practices in Arizona, Colorado, Delaware, Maryland, and Tennessee. Renowned for its integrated urologic care programs, patient-first approach, clinical excellence, and innovative treatments, the group operates with 126 offices, thirty-two ASC, and is powered by a dedicated team of over 1,500 employees, anchored by 220+ clinicians.

Challenges

The provider faced a significant challenge in managing prior authorizations for services, exceeding $100 million in value. More than half of these services required authorization within two hours of the patient’s visit, leading to rescheduled appointments and increased denials due to delayed authorizations. Compounding this was the manual nature of the process, staff turnover, and intensified scrutiny from payers.

Volume and time sensitivity

Over $100M in services required prior authorization, with a tight window of two hours for over 50% of cases.

Manual processes

The existing process was entirely manual, leading to inefficiencies and high rate of errors.

Increased denials and rescheduled appointments

Staff turnover and heightened payer scrutiny resulted in more denied authorizations and increased rescheduling of patient appointments.

Solution

Digital empowerment in prior authorization

When faced with the intricacies of the prior authorization process for the provider, Ascent designed and implemented a digital-centric approach, fully utilizing the capabilities of the ARMS Ai platform and domain expertise. This approach focused on enhancing patient engagement services and refining the entire revenue cycle for urology care. Ascent’s solution was characterized by a comprehensive and integrated deployment of digital tools:

Advanced Automation

The ARMS Ai platform was configured to automate the prior authorization process intricately. By directly interfacing with the scheduling systems, it could autonomously pinpoint which procedures required authorization, thereby streamlining the workflow, and ensuring that follow-ups on pending authorizations were automatically managed.

Open Loop Modeling and Machine Learning

Over 2,000 Open Loop Models were employed across the entire Urology Revenue Cycle Function, with a particular emphasis on prior authorizations. These models were engineered to process the 324,000 annual procedures occurring in four distinct U.S. regions, applying machine learning to sift through data and extract the essential clinical information needed to expedite the authorization process.

Rule-Based Algorithms

The platform’s intelligent algorithms were specifically designed to discern and flag procedures that necessitated prior authorization, ensuring nothing was missed and that all required authorizations were pursued promptly and accurately.

Best-in-Class Protocols

Ascent is committed to the utilization of best-in-class protocols, ensured that every step of the authorization process not only met but exceeded industry standards for efficiency and patient care.

Outcomes

The digital strategy led to a tangible reduction in rescheduling rates, significantly curbing denials for prior authorizations, and, most importantly, fostering an increase in cash flow. The 100% improvement in prior authorization directly improved patient experiences, operational efficiency, and financial health.

Improved Patient Experience

Faster and more reliable prior authorization processes meant fewer delays in care delivery, directly benefiting the patient experience.

Reduced Reschedule Rates

The streamlined process led to lower rates of rescheduled patient appointments.

Decreased Denials

Automation and improved protocols resulted in fewer denials due to lack of prior authorizations.

Enhanced Cash Flow

The improved efficiency positively impacted the medical group’s cash flow.

Enhanced Efficiency and Accuracy

The automation and algorithm-driven processes significantly reduced the time and resources traditionally required for prior authorizations. Ai and machine learning models provided a deep understanding of regional and procedural specifics, leading to a higher accuracy rate in the authorization process.

325,000

Procedures authorized
annually by ML models

15

Day improvement
in prior-authorization process

1 M+

Manual
touchpoints eliminated

The streamlined process not only addressed immediate challenges but positioned the medical group for sustained success in a dynamic healthcare landscape. The successful implementation of Ascent Health Solutions’ Patient Engagement services yielded significant improvements in efficiency, patient satisfaction, and financial outcomes. The Urology network set a new benchmark for the integration of technology in healthcare revenue cycle management.

“We would have never been able to achieve the outcomes we did without Ascent.”

VP RCM

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