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
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
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.
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
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
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.
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!
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.