With more than 40 medical and surgical specialties, Cookeville Regional Medical Group (CRMG) provides most of the specialty care for residents in the Upper Cumberland region of Tennessee. And that means pre-authorizing hundreds of visits and procedures every day.

Before CRMG started using athenaOne® Authorization Management, a staff of more than 10 people spread across nine offices conducted authorizations using a paper-based process. Authorizations typically took seven to 10 days. Employees spent most of their time on the phone and searching online for the information they needed. Plus, they didn’t have an effective way to monitor open cases. “Sometimes our follow-up buckets held hundreds and hundreds of cases,” said Monica L. Morrison, director of practice operations.

CRMG implemented Authorization Management to support 65 providers working across 13 specialties. Now, as soon as a provider orders a medical service in athenaClinicals, the service automatically begins processing pre-certifications for procedures, surgeries, imaging and primary care provider-to-specialist referrals. A rules engine checks the order against payer requirements to determine if an authorization is required, saving staff from wasting time researching authorizations that aren’t necessary. If an authorization is required, athenahealth’s authorization team communicates directly with payers to submit documentation, follow up on status, and manage the authorization to completion. The service continually adjusts to changing payer regulations.

Morrison and her team noticed improvements right away. “The Authorization Management service dramatically cut down on our employees’ telephone and online time,” said Morrison. CRMG was able to centralize and decrease the number of employees working on authorizations. “We have four employees in charge of authorizations across the entire organization,” said Kim Dixon, team leader. “Our team and process are significantly more efficient.”

Reducing pressure on staff and enabling prompt appointment scheduling

CRMG is now able to schedule appointments and procedures within 48 hours instead of waiting a week or more for authorizations to be completed. In fact, most authorizations are completed in two days and more than 98 percent of non-urgent authorizations are completed within seven days. The average time to obtain authorizations has been reduced by a full week.

Day-to-day stress for authorization employees has been eased as well. “Instead of having hundreds of notes in our follow-up bucket, athenahealth handles our authorizations without additional effort needed from us,” said Dixon. Her team can easily communicate with athenahealth’s authorization specialists and use an in-system tool to see the status of authorizations in process. 

Efficient authorization management is just one aspect of their partnership with athenahealth that helps improve the patient experience. “Like everything else, the authorization management service is well integrated into the athenahealth platform,” said Morrison. “Every feature of athenahealth’s services, from telehealth to quality reporting, is effective, easy to use and helps us focus on patient care.”