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Precertification Authorization

Renowned Orthopedic Hospital with Under-Utilized MRI Slots!

This Orthopedic Specialty hospital was losing valuable high-dollar MRIs,CTs, PETs, NMRs,  to ‘local’ facilities. Phoenix took over the Authorization process and provided the end-to-end Precert service, calling the Practices, the Patients, the Insurance Companies and the Radiology Schedulers to keep the patients for the facility. This achieved a 65% decrease in leakage to other facilities.

This facility had 8 MRI suites and 6 CT machines ready to see patients all day. But on any given day, they were grossly under-utilized, and some rooms went hours without a patient. Yet, the several hundred physicians on site, were seeing hundreds of patients per day, with a huge percentage needing a diagnostic MRI or CT. Since Phoenix has taken over their precerts and filled every available slot, they have added 8 more MRI suites and 4 more CT suites, opened a full service facility in the neighboring county, and full service facilities in two other states!

Previously, each Provider’s staff was so busy checking in patients, answering phones, setting up scripts for these tests and for medications and surgical procedures, that the Precertification Authorization process (Precerts) was just too time consuming to be a priority.  As a result, the staff gave the Scripts to the patients and told them to go schedule at a facility of their choice and to bring those results with them at their next appointment.

Not only did this result in tens of thousands of dollars lost per day for the facility, but the quality of the films was sub-par and the physicians were unhappy performing surgery based on them.

Phoenix utilizes practice-trained insurance specialists to make those calls to the insurance company as opposed to an online request without human interaction. Our specialists’ knowledge provides the ability to present and argue the case to the insurance company agent who desperately wants to refuse the authorization. The skill and expertise of our specialists changed this facility’s denial rate from 35% with their former process, to a 98% authorization success rate.

Phoenix developed a proprietary portal for tracking all precert requests and the immediate status of every one. Phoenix retrieved the information from the EMR system, made the calls to the insurance company, obtained the authorization within minutes to a few hours, scheduled the visit for the patient at the facility, provided the authorization numbers to the facility and filled the info back into the EMR, completing the process.

The result was the MRI and CT scans were used to capacity, and the facility built more rooms, and added off site locations to accommodate the demand.  The physicians’ staff did not have to spend that valuable time, and the facility got to keep that revenue instead of it ‘leaking’ to outside standalone shops.  Their revenue was increased by 65% in the first year, and more since the addition of those new machines.



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