Dramatically improving the efficiency and economics of the prior authorization/referral process for healthcare providers is an objective shared by providers, TIPAAA and Wybtrak.

The following case study highlights just some of the benefits associated with TIPAAA's Prior Authorization/ Referral Solution by Wybtrak.

Overview:

This case study documents the changes in the workload and use of Wybtrak's Medicom software in an 8-physician Primary Care Clinic.  Due to the number of patients being served at this clinic, two full-time prior auth/referral clerks were required to manage the patient load.  The administrator of this clinic determined that the referral clerks needed to modernize the way they were making referrals.  The administrator decided to test the Medicom referral/prior authorization software, to determine if the product could reduce administration and improve the overall process.  To do this, Medicom was installed for one of the clerks, while the other continued working manually as before (to serve as a baseline for the comparison).

The Problem:

The workload for the test-clerk was so large that when she came in on Monday and began processing the files from Friday evening and the weekend, she was unable to catch up with the normal daily work until late Thursday.  This workload prevented the clerks from taking vacations.  A single day lost to illness required that she work extended hours for several days to catch up on the prior authorizations and referrals.  This situation made for an extremely unhappy work place.  Because of the self-imposed stress to "keep up" with the workload, there was much competition for resources and a mind-set of "do not bother me because I have too much to do already."  Consequently, there was very little communication and almost no mutual support between the clerks.

The Solution:

Wybtrak, Inc. installed the Medicom prior authorization/referral system at one clerk workstation and trained the clerk for two (2) hours.  The clerk quickly became comfortable with the Medicom system and began processing her backlog.  Within just a few days of using the Medicom system, the clerk was able to completely process her backlog of patient files and was caught up for the first time since she began working for the clinic!

Now when the clerk comes to work on Monday morning, the backlog of prior authorizations and referrals from the preceding Friday, the weekend AND Monday is completely processed by 2:00pm Monday afternoon.

The Benefits:

At the end of the test period, the improved efficiency positioned the Medicom clerk to not only finished her own work, but also routinely assist the other clerk. This has measurably improved morale in the clinic.  The workload is now manageable. 

The turnaround time on Prior Authorization Requests has been dramatically reduced. The referral and prior authorization requests are now fast and easy to complete, resulting in greater accuracy and productivity. This eliminates mistakes that in the past required the clerk to correct and re-send requests and/or spend long periods of time on the telephone with the payors explaining the requests and tracking down supporting records.

Efficiency has also improved because the clerk no longer has to spend time tracking down misplaced paperwork to be sent, or re-sent, with the requests.  All of those individual pieces of paper that used to become lost or damaged can now be made a permanent, electronic part of each request.

The reporting capabilities of Medicom allow better tracking of outstanding requests.  The clerk no longer has to spend wasted time digging through patient files and on the telephone attempting to determine the status of each request manually.  As an example, one of the standard reports included with Medicom provides a list of which requests have not yet been given authorizations.

The administrator can now determine which specialists their practice utilizes and how many referrals are made each month to those specialists.  This allows the practice to better manage and negotiate their contracts.

The Future:

As a result of the improvements shown by Medicom in this practice, the clerk who was still doing referrals and prior authorizations manually is now clamoring for her own Medicom.

The clinic is in an expansion phase and has already installed Medicom in two additional offices. The clinic plans to have the Medicom prior authorization/referral software installed in five more locations as soon as they are finished building them! 

Wybtrak's Medicom is network-ready and can share data between multiple sites so the clerks do not have to re-enter the same information at each location.  The up-scaling of the Medicom system is simply a matter of adding seats and providers as needed.

Wybtrak will be there for this practice - meeting their needs both now and in the future!

For You:

Medicom offers numerous options to providers and is scalable from a single standalone PC on up.  Medicom can be installed in a myriad of ways that leverages existing work habits, policies, equipment and organizational structures to the best advantage for the practice.

Wybtrak will be there for you - meeting your needs both now and in the future!

For more information, please contact us.