JP Bader

Case Study: The administrative burden continues to rise

Jordan works as an administrator for a small, 3 doctor, general care practice. Office responsibilities have Jordan, and one other administrator, cover a wide range of responsibilities. These include fulfilling the duties of a medical assistant, receptionist, biller, and any necessary pre-authorizations. To accommodate patient needs and offer hours outside of the usual 9am-5pm, only one administrator works at any given time.

To keep everything running smoothly, Jordan has to constantly shift between tasks. Jordan faces interruptions from patients and the phone, while working on insurance-related administrative work. The patients are always the top priority, followed closely by the administrative work to get paid. However this sometimes means less time sensitive administrative work, like billing and pre-authorizations, are handled during hours when the office is closed, or expected slowdowns. When interruptions are minimal, a bulk of the administrative work gets done. Phone calls to insurance companies are particularly difficult because the hold time can be unpredictable, and Jordan cannot afford to be on the phone for 30 minutes while patients are checking in for appointments or calling the office with questions. It is even harder when the calls might only get done when the office is slow, closed, or quiet, because insurance companies might not even be open at that time.

For example, one of the doctors at the practice saw a patient suffering from headaches. The doctor recommended an MRI and referral to a neurologist. Because of the administrative burden created by insurance companies, the ten minute appointment for the doctor turns into 30-40 minutes of work for Jordan. Jordan now has to submit the claim for the office visit (as usual), then also contacts the insurance company for pre-authorization, submit the referral, relay the MRI and referral information to the patient, and update the patient records.

In this scenario, the patient has an HMO with an uncommon insurance company, which adds more complexity to the workload. First, Jordan has to visit the payer’s website, find an in-network neurologist, and verify the neurologist is accepting new patients. Next, the same is done for the imaging center, because the location most patients are referred to is not in-network. Finally, Jordan calls the insurance company to submit the referral. The neurologist referral must be faxed, and the authorization for the MRI is handled by a different company, so the call is transferred. After 10 minutes of hold time, Jordan is informed that the MRI does not need authorization for an in-network provider. Jordan then prints the referral, fills it out by hand, and faxes the form to the insurance company. After faxing the form, Jordan contacts the patient with the referral information for both the neurologist and MRI location. The patient was upset because the neurologist is far away, and Jordan spends a significant portion of time explaining the health plan and that the neurologist is the closest in-network option.

Sound familiar?

If you work as an administrator for a small-medium sized office, this might be your workload. If you wear many hats, trying to balance so many responsibilities may be burdensome. Administrators are always looking for any solution to complete work faster and more efficiently. Some service providers and hospitals have taken advantage of this fact by offering to handle pre-authorizations for their services. It is understandable that practices would be eager to refer their patients to these service providers, when quality is the same.

Next Health Choice can help

Next Health Choice offers a simple, streamlined service for obtaining pre-authorizations. Administrators can work with Next Health Choice directly to remove the burden of pre-authorizations for all services, regardless of service provider. No need to pick up the phone, fax paperwork, or know the intricate details for each payers rules. Next Health Choice can help keep the administrative work more proportional to the time spent with the patients.

Service providers can bring in more patients by using Next Health Choice as a marketing tool. Offer pre-authorizations as a free service for all referring physicians to increase the number of physician referrals and watch your bottom line grow!

More patient time, less office work

Get in touch with Next Health Choice today to learn more.


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