‘A game changer’

Allegro Family Clinics are located in Columbus, Mississippi, which is also home to a large Air Force base. A sizeable portion of the patient population includes service members and their families, who have TRICARE military insurance. Their coverage requires prior authorizations for more services than many commercial payer plans. That means half to a third of the roughly 300 patients seen weekly across all four clinics require prior authorizations, estimates nurse and office manager Erin Taylor. Each manual prior authorization used to take Taylor and fellow staff 30 to 45 minutes to obtain by calling payers to check on frequently updated coverage rules.

Streamlined process promotes patient and provider satisfaction

Since they started using athenaOne® Authorization Management, Allegro has noted improved provider and patient experiences. Those 45 minutes have been drastically whittled to in many cases two minutes, said Taylor. As soon as providers order a medical service or specialist consult in athenaClinicals, the service automatically begins processing pre-certifications and referrals. A rules engine checks the order against payer requirements to determine immediately if an authorization is required. If it is, athenahealth’s authorization team communicates directly with payers to submit documentation and follow up on authorization status. The results, says Taylor, are even better than anticipated.

“When we thought it just did the pre-search for TRICARE imaging and diagnostic studies, we were like, ‘Oh my gosh, this is fantastic.’ When we learned Authorization Management actually went through and [also] did specialist referrals for us through the TRICARE site, we just couldn’t believe it!” Across all accepted insurance plans, approvals previously took up to a week. Now it typically takes just 24 to 48 hours to hear whether prior authorizations are approved.

Not only can services get scheduled faster, but patients and providers have better peace of mind, Taylor said. Cutting the amount of time patients have to wait to find out if they’ve been approved eliminates the stress of uncertainty. And, efficient documentation from the athenahealth team means it’s easier to keep track of requests and communicate progress with patients. “athena updates you every step of the way,” said Taylor. “And they put in there, ‘I spoke to so-and-so at this number.’ There’s no guessing about it — they’re documenting very efficiently and accurately.”

Her day-to-day as a nurse is better thanks to Authorization Management, she said. “I need to be worried about my patient in the office, if they are hooked to IV fluids or we’re trying to give medicine, versus being on the phone with the insurance company for 45 minutes. If I have a patient that I think might have appendicitis and it’s close to rupturing, I can put ‘stat’ on it and athena recognizes that this is an emergency. That’s a life or death situation.”

I need to be worried about my patient in the office, if they are hooked to IV fluids or we’re trying to give medicine, versus being on the phone with the insurance company for 45 minutes.

Greater efficiency results in fiscal sustainability

Taylor said that athenaOne® Authorization Management greatly supplements the efficiencies of using athenaOne, and that Allegro has been able to decrease the number of full-time employees due to fewer required phone calls and little to no paperwork left. Streamlining staff meant that unlike many practices facing financial hardship due to a reduction in patient volume, Allegro Family Clinics is more fiscally secure. That alone is “a game-changer” Taylor said.