Care New England reports a 55% reduction in authorization-related write-offs since automating radiology prior authorizations and notice of admissions
Care New England (CNE) is Rhode Island’s second-largest hospital system. CNE has seven operating units, including Butler Hospital, Women & Infants Hospital, Kent Hospital, the VNA of Care New England, the Providence Center, and the Care New England Medical Group. Their combined mission is to provide exceptional care with kindness and compassion and be a trusted choice for care whenever and wherever patients need it.
To align with this mission, Care New England (CNE) recently partnered with Notable. The goal of the partnership was to reduce manual touches and errors within the revenue cycle to enhance the speed and quality of care delivery and ultimately also have an improved financial impact. Specifically, CNE is leveraging intelligent automation to automate the highly manual notice of admission (NOA) and prior authorization processes. The NOA process is especially high stakes due to its high-dollar and time-sensitive nature, as well as meticulous and varying payer requirements.
“We have two different EMRs. We have different systems that staff need to interact with on a daily basis, along with following specific rules that vary by payer. With Notable, we were able to standardize and remove the margin for human error - things as simple as mistakenly faxing to the wrong number. Our process is more accurate and reliable because Notable is following steps coded into an automated workflow. There is no guesswork.”
hours saved for NOA and prior authorizations work
NOA success rate
prior authorization success rate
projected write-off and cost-savings within 12 months
reduction in authorization turnaround time
The challenge
Providers are increasingly facing shifts in payer mix, such as patients moving from traditional Medicare to more Medicare Advantage plans, or changes in payer requirements for authorizations altogether. These changes in payer mix can increase authorization volumes, which increases the amount of work staff must do to obtain, status, and submit them. This process is even more challenging given the staffing shortages that persist across the healthcare industry; such shortages are especially acute in the revenue cycle domain.
CNE recognized an opportunity for automation as a way to increase productivity without hiring additional staff or incurring costs. During a process improvement review, CNE estimated each NOA or authorization took ~15 minutes to complete, and that they would need to hire an additional 14 FTEs to keep pace with the amount of work. What’s more, the average turnaround time for submitting a prior authorization to getting a patient scheduled was nearly 10 days, resulting in patient frustration and provider frustration.
The solution
Using Notable to streamline NOA and prior authorization processes has allowed CNE to reallocate staff time to high-value initiatives including time consuming federal requirements related to the No Surprises Act. Additionally, CNE has been able to reduce staff overtime due to the significant volume decrease of work offloaded to Notable. The volume shift has also allowed CNE to operate more efficiently if staff are ill or out of the office.
Since deploying Notable, CNE has increased staff capacity to take on new and more complex payer requirements. As a result, CNE reports a 55% reduction in authorization-related write-offs, 2,841 hours saved for staff, and more.
