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Myndshft Blog

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October 24, 2022

Success Starts Here: Empower Your Physical Therapy Staff with Prior Authorization Software

by Susan Lawson-Dawson | Prior Authorization

You can’t escape news about the hiring headaches plaguing healthcare. Even before the pandemic’s disruption, experts were predicting staff shortages across the healthcare industry, and competition for workers has only intensified since 2020. Recently, MedCityNews opined, “The ‘Great Resignation’ should spark a great transformation, where digital innovation is no longer a stop-gap but an integral part of any health care delivery strategy moving forward.” Prior authorization software is one such solution. 

Strategies that complement digital transformation

Ricky Overton, Director of Revenue Cycle at Inspired Physiotherapy, shared in a recent webinar how he implemented a training program to address a huge revenue cycle challenge: prior authorization. More than a decade after leaving the hospitality industry for healthcare, Ricky was tasked with addressing revenue losses stemming from claim denials. The main culprit? “Prior authorization was our #1 denial bucket,” he explained. 

Ricky realized that lessons he learned from running a restaurant could prove useful in healthcare too. “In restaurants, the focus is on creating a positive customer experience AND turning tables around quickly,” he recalls. Expeditors kept the rhythm going. Staff cross-trained for different duties so they could fill in as needed. He decided to put those strategies to work to optimize the revenue cycle at a multi-state physical therapy provider. 

Prior Authorization Triage Role

Ricky established a new role: prior authorization triage. The triage person was tasked with reviewing prior auth denials, identifying the denial causes and providing that information to the appropriate staff for resubmission. The triage person also forged relationships with utilization management nurses to better understand what information they needed to approve prior authorization requests without an additional medical review.  Like expeditors at a restaurant, the triage person enabled a smoother flow, ensuring patients could get the services needed with fewer denials and faster approvals. 

360-Degree Staff Training

In addition, Ricky realized that staff training was falling short. “No one had a complete understanding about the life of a claim through the  revenue cycle.Training was stagnant. Staff had a “check the box” mentality. People weren’t formally sharing knowledge within or across teams, and the lack of knowledge was causing errors and delays in care,” he shares. 

He brought together a committee of individuals representing different points in the revenue cycle—from patient intake and scheduling to billing and collections. Together, they put together a more comprehensive training program. “When your staff operate in their own bubbles, they have limited visibility into how their activities affect processes upstream or downstream. Training that offers a big picture view gives your staff confidence and improves the quality and quantity of work they do,” he says. 

Centralized patient intake 

With rev cycle responsibilities for 224 clinics across 7 states, Ricky also centralized patient intake.  He notes, “Earning patient buy-in is crucial. Some patients come to physical therapy as skeptics. The sooner you can get them into treatment and start relationship building, the better.” By centralizing one of the biggest administrative burdens for clinics, Ricky enabled clinic staff to stay focused on patients, not paperwork. Eventually, he further streamlined the workflow by developing an app that allowed batch processing and routing of verifications. 

Prior authorization software is a game-changer

“Our teams were productive and moving through the work, but it’s still a lot of manpower, so I really was looking to automate,” says Ricky. His developers created an app for prior authorization, but when they began testing bots for automation, interoperability challenges proved frustrating.  He just didn’t have the development team or time to devote to such a complex undertaking. Then, he was introduced to Myndshft. “There are a lot of people out there that say they can submit prior authorizations for physical therapy or other specialties, but not to this caliber.”

One challenge that slowed internal development of a prior authorization app was the sheer number of payers and plans to contend with. With Myndshft, the heavy lifting is already done. Our extensive payer rules library and self-learning rules engine maintains up-to-date eligibility and prior authorization rules for more than 700 payers.  Combined with intelligent automation and best-in-class interoperability, Myndshft requires minimal data entry to conduct: 

  • Verification of benefits
  • Insurance discovery for secondary/tertiary coverage
  • Calculation of patient financial responsibility
  • Prior authorization determination, pre-check, submission and tracking

This frees your staff for higher value, patient-centric tasks. Not only does that equate to happier staff with less turnover (a boon given today’s hiring challenges) but it also leads to better patient experiences. Not to mention, a healthier bottom line

Ready to see prior authorization software in action? Contact us.