Case Study
MEDITECH Assessment Yields 75% Reduction in Authorization Denials
- Customer: An Indiana health system
- Challenge: Assess revenue cycle on MEDITECH Expanse to understand and reduce authorization denials
Results
Identified opportunities to:
- Reduce authorization denials by 75%
- Increase revenue associated with scheduling outside orders
- Improve efficiency in the timeline scheduling of patients
- Improve communication with clinical staff
Background and Challenge
After an Indiana healthcare went live on MEDITECH Expanse, they uncovered opportunities to improve scheduling, communication, and authorization denials. They engaged Tegria to assess the potential impacts to patient care and revenue and recommend targeted interventions.
Solution
Tegria performed a weeklong, on-site assessment to better understand the breadth and depth of the issues the organization was experiencing. The team’s lead MEDITECH expert conducted three days of staff interviews and workflow discovery sessions across 26 different areas/departments.
The Tegria team also performed an in-depth system review, focusing primarily on dictionary build, worklist build, and denial review on the Financial Status Desktop. They found that improper build and failure to check secondary/tertiary insurance for authorization were contributing to denials. Failure to schedule outside orders resulted in missed revenue.
While the assessment initially focused on scheduling and prior authorizations, Tegria’s experts also identified and recommended fixes for important issues pertaining to patient care, outdated or incomplete processes and workflows, inadequate training, and incomplete system configuration.
Results
Tegria identified and documented 24 findings, then presented recommendations with estimated benefits, including:
- 75% reduction in authorization-related denials
- Improved efficiency in the timely scheduling of patients
- Increased revenue associated with scheduling outside orders (not previously scheduled)
- Improved and timely communication with clinical staff