By Sandra Edson, MBA
Does your imaging center experience write-offs or denials contributed to a lack of medical necessity, authorization, or other documentation issues? If your answer is “yes,” you’re not alone. Based on Tuesday’s session “Having Issues with Write-offs and Denials? Learn About the Initiative and Implementation Process That Improved Our Overall Volume and Reimbursements,” many organizations are challenged with the same struggles. The presenters in this session shared their experience of undergoing a process improvement initiative to turn this around. During their journey, Stanford Health Care leaders streamlined workflows and achieved substantial improvements in patient experience, reduced denials, increased volume, and optimized authorization and scanner utilization.
Stanford Health Care, a large academic center located in Northern California, provides over 680,000 imaging visits per year, spread amongst a dozen images centers in the Bay area. The health network experienced challenges in obtaining appropriate orders, which led to re-work, write-offs, and delays in turnaround time. Initially, they perceived the problem to be related to the technical staff but quickly learned the issue was a result of their workflow.
With a comprehensive staff consisting of 191 radiologists, fellows, and residents plus 270 imaging personnel, this was not an easy undertaking. By pulling a team of key stakeholders together, dedicated to improving the process, they achieved significant improvements. Their team consisted of the following individuals:
- Imaging Services
- Scheduling, Radiologists, Informatics, and Technologists
- Patient Financial Services
- Patient Access Services, Authorization, Patient Financial Counselors
- Referring Providers
- Nurse Practitioner, Physicians, Residents, Clinic Managers, Physician Assistants, and Fellows
A Clinical Exam Coordinator position was established to work with the team. During this process, the team analyzed their current workflow and identified authorizations, lack of medical necessity, and changed orders to be most common reasons for denials. The scope of their project included high end procedures, with MRI experiencing the highest level of denials.
The end result is a new protocol driven workflow which involves the radiologist and technical staff reviewing orders prior to scheduling and obtaining authorization. This provides opportunities for the imaging team to work collaboratively with the referring clinicians. Their key drivers and interventions are listed below:
Key Drivers and Interventions:
Improve Patient Experience-
- Correct resource for the procedure based on scanner functionality.
- Ability to resolve order discrepancies earlier in the process.
- Ongoing discussions with ordering clinicians regarding more relevant clinical history.
Timely Secured Authorizations-
- Ongoing discussions and feedback with pre-authorization group regarding the status of authorization at time of the procedure.
As a result, Stanford Health Care was successful in demonstrating significant improvements; including a 50% reduction in MRI changed orders. In addition, denials decreased to $83,000 (YTD-2015) compared to $1M in 2012 when this project was implemented. The team also demonstrated improved utilization of the scanners, decreased turnaround time, and a reduction in re-work. During the session, the imaging leaders from Stanford Health Care noted that the workflow change was the gem of their improvements.
The next step of their journey will include an imaging utilization performance improvement plan, developing mechanisms to measure adherence of evidence based guidelines, and implementing Clinical Decision Support (CDS) as required by CMS starting January 1, 2017.
If you are experiencing challenges with write-offs and denials, don’t give up. Similar to Stanford Health Care, you can also make a difference in your organization by reviewing your workflow, involving key stakeholders, and learning from the successes of other AHRA members.