2016 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks of

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1 2016 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks of Experian Information Solutions, Inc. Other product and company names mentioned herein are the trademarks of their respective owners. No part of this copyrighted work may be reproduced, modified, or distributed in any form or manner without the prior written permission of Experian. Experian Public.

2 Introducing: Brandon McCord Ochsner Health System Martha Mancino Co-Presenter Experian Health 2

3 Innovate your Auths The path toward a streamlined Authorization Process

4 Who we are 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 4

5 Why Innovate? 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 5

6 Desired Outcomes & Considerations 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 6

7 What we did - Real Time Passport Authorizations 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 7

8 Process Overview 8

9 New Process through RTA 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 9

10 Who we are Pre-workflow Post-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 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 10

11 Real Time Auth Workflow Pre-Service users then check the External electronic authorization checkbox in the referral on the Authorizations form. 11

12 Auth/Certs Notification Event for RTA Notification History form was added This is where we track RTA productivity 12

13 Process Overview 13

14 Ping or Inquiry History 14

15 RTA Process Moves on 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 15

16 Example RTA Authorized Note Speaker intro or subhead goes here 16

17 What if it not Authorized 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 17

18 Project Impacts 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 18

19 Things to Consider 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? 19

20 Lessons Learned 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 20

21 Thank you & Any Questions? 21

22

2016 Experian Information Solutions, Inc. All rights reserved. Experian and the marks used herein are service marks or registered trademarks of

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