Claim management simplified

Like most practices across the United States, Southwest Orthopedic Associates (SOA) spent an inordinate amount of time and effort managing claims. For Nikki D’Alessandro, Office Manager of SOA, constant claims follow-ups and document management consumed at least six hours out of every eight-hour workday. This didn’t leave her much time to focus on other high-value tasks. To resolve these challenges, SOA adopted athenahealth’s Authorization Management and Enhanced Claim Resolution solutions in 2020. According to D’Alessandro, this decision has put Southwest Orthopedic Associates on the pathway to growth while also freeing up 95% of her workload.

A truly rewarding partnership

If done manually, determining if an order needs to be authorized could take up to 45 minutes and require lengthy, back-to-back phone calls. The rules engine built into the Authorization Management solution automates this task, saving time and money for the practice. Orders are then sent to athenahealth’s team of authorization specialists, who manage documentation and follow up with payers on behalf of the practice.

 “It is wonderful to see how they submitted the authorization, the people they called, the detail of information they have,” D’Alessandro said. “Authorization management has been a lifesaver for us, especially with surgical and MRI authorizations.”

Another challenge SOA faced was lack of clarity regarding medical coding and claim denials. Being immersed in the complex world of medical coding was already mentally exhausting. Coupled with that, hours spent on the phone with payers to determine the reasons behind denials led to massive burnout. Enhanced Claim Resolution is now at their disposal to review complications in policies and coding and resolve denials and insurance credits. This has not only simplified workflows around the clinic, but also resulted in a 63% uptick in payment responses.

“Copious notes are expertly and simplistically laid out within the claim itself, making it very easy for us to understand what’s going on,” D’Alessandro explained. “So, working on A/R is a breeze for me, compared to how it used to be when we didn’t have Enhanced Claim Resolution.”

A shift in priorities

Going live on both services has allowed the SOA staff to deep dive into internal workflows and bridge gaps between the clinical and administrative aspects of the practice. Thanks to athenahealth’s embedded tools, such as payment mismatch tracking wizard, they’ve been able to closely track payment trends and evaluate the efficiency of payment collection. “These two services have absolutely helped us catapult into carefully examining where our inefficiencies are as a small practice and what we can do better,” D’Alessandro said.

An exchange of ideas and trust

The interactive experience offered by athenahealth’s solutions is another quality that makes athenahealth stand out to D’Alessandro. “These solutions are not just comprehensive; they are consultative as well,” D’Alessandro said, referring to athenahealth’s user groups that facilitate feedback from and dialogue between practices of all sizes and locations. “The feedback models blow my mind all the time because it clearly shows that athenahealth cares about the practices and our voice. We are part of a communal atmosphere where there are other orthopedic groups out there — small and large — who reach out to us for ideas, or may share their best practices that we never thought of.”

As a word of advice for those who have yet to become a part of the athenahealth community, D’Alessandro said: “You are not going to run the same show as you used to once you go live on athenahealth because it’s going to be better. And just about a year into utilizing their services, you’re going to find how inefficient you were before.”

Beyond providing administrative support and a forum to share ideas and best practices with other orthopedic groups, athenahealth has ultimately helped SOA achieve more efficient workflows and D’Alessando reclaim her workday.

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