Putting the Focus on Authorizations and Referrals Reaps Big Financial Benefits at New York Eye & Ear Infirmary
(7/25/2007)

The fiscal well being of any health care organization can be greatly affected by how well the institution manages even the earliest points of a patient's care process. For this reason, the folks at the prestigious New York Eye and Ear Infirmary (NYEE) in Manhattan rely on MEDITECH's Authorization and Referral Management (ARM) functionality to handle important information up front, which also helps ensure timely reimbursement for the services they provide.

"Managing authorizations and referrals is a crucial revenue cycle, bottom line issue, and MEDITECH's ARM software helps us deal with these front end processes quite successfully," states Don Ushak, I.S. director at NYEE.

Previously using paper to track authorizations and referrals, NYEE's hand-written records lacked important detailed information, and had a negative impact on staff workflow, patient satisfaction, and ultimately, the organization's financial health.

"Patients were running out of authorized visits without realizing it, and as a result, we were losing out on reimbursement for those services. We needed a more formal way of tracking data than our manual method of counting down previous visits and chasing paperwork," says Ushak. "MEDITECH's Authorization and Referral Management came at just the right time."

Going with the Flow: ARM Makes Internal Processes Run Smoothly, Improves Reimbursement
MEDITECH's ARM software tracks all information associated with authorizations and referrals, and as a result, Scheduling and Registration staff have the necessary details when needed. "The diagnosis and CPT codes are clear," says Marianna Gorbaty, medical systems manager at NYEE. "We did not even have a tool to document this information before."

Furthermore, she explains the "clear" and "precise" information collected on-line increases the likelihood of getting reimbursed for services later on. "Prior to ARM, we relied on verbal authorizations for treatments and procedures. Now that the hospital documents the information, we have the records to back us up when dealing with insurance companies," explains Gorbaty.

The functionality has made a positive impact internally with workflow as well, making care delivery a much smoother process for all. "ARM is very user friendly and we are finding it decreases the chances of miscommunication among staff," according to Gorbaty. This sentiment is echoed throughout the NYEE outpatient clinics, where each individual facility is responsible for compiling its own reports using ARM. "ARM complements our decentralized environment and helps us easily produce standard compiled reports in our various clinics," says Gorbaty.

Patient-Centric and Financially Focused: ARM Provides Critical Link to Scheduling
NYEE is finding ARM perfectly supports their health care delivery needs, due in large part to the software's integration to the scheduling process. "I was convinced that referrals needed to be linked only to Registration," Ushak says. "But, having seen it in action within our own setting, it absolutely needs to be linked to Scheduling."

Now, staff can verify information before scheduling appointments and be confident it is accurate. Plus, if something is out of place, the patient has days or even weeks to get the matter corrected.

"Patients know their referral status well before they arrive at the hospital. This is crucial for us since we have so many patients coming and going on any given day," Gorbaty explains.

When scheduling a patient, staff members have complete information of not only how many referrals a patient has left, but also exactly what they are. "It is important to get this information up front, before they end up in our waiting room. We want to prevent any unnecessary stress on both patients and staff members, and ensure all paperwork is handled appropriately, as this affects our ability to get reimbursed for services," says Gorbaty.

Synergy Between Customer and Vendor Leads to Better Product in the End
Being one of MEDITECH's first MAGIC sites to use the ARM product, NYEE provided valuable feedback which greatly enhanced the product development process.

"We spent hours prior to implementation working with MEDITECH," explains Gorbaty. "They went over every aspect of the system and how it should work. More importantly, they listened to what we needed. It never felt like they were just installing software. It was as though they were making a product for us."

MEDITECH's close partnership with the NYEE staff allowed end users to not only see how the application worked, but also how the insurance companies managed patients. As a result, staff members not only understand the system, but also better understand the referral process from the insurance company end.

"Our staff gained a lot more knowledge about insurance company standards," Ushak says. "The value of that information is immeasurable for reimbursement purposes."

With the Right Tools, NYEE Attracts Top Clinicians and Improves Care Delivery
Whether based in a big city or small community, health care organizations are always competing for the most talented doctors. According to Ushak, part of obtaining and keeping the best talent is providing doctors and researchers with the most advanced tools to perform their job. This is especially necessary given NYEE's close proximity to numerous other competitive health care organizations located up and down the East Side of Manhattan, in New York City's well-known 'Bedpan Alley.'

"You have to show doctors that you are an advanced organization," says Ushak. "If you can't handle the business and administrative tasks properly, what does that say about your organization? For us, ARM helps provide that extra technological edge we need to compete with other top health care organizations, as well as enable clinicians the best tools for providing quality care to patients."

 

About New York Eye and Ear Infirmary
Founded in 1820, New York Eye and Ear Infirmary (Manhattan, NY), is the oldest specialty hospital in the Western hemisphere. A not-for-profit organization, NYEE performs approximately 142,000 outpatient visits and more than 20,000 surgical procedures per year, making it the largest provider of eye care in America. NYEE emphasizes the use of innovative technology to maintain its position as a worldwide leader in ophthalmology and otolaryngology.

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