Award-Winning Orthopedic Group Reduces Denials and Peer-to-Peers with Artificial Intelligence

Background

An award-winning orthopedic practice affiliated with New England Baptist Hospital has consistently been voted one of America’s top hospital systems by U.S. News and World Report. Their 14-surgeon team specializes in sports medicine and a broad range of orthopedic injuries at their 3 locations in the Greater Boston Area.

Challenge

With over 4,000 procedures per year, a growing patient base, and an expanding roster of surgeons, the burden of prior authorizations was felt greatly at BSSC. Each surgeon had a dedicated Surgical Coordinator who focused on patient care and clinical support, as well as prior authorizations. They had little administrative time to complete prior authorizations, and with the time they did have, struggled to keep up with the growing volume of authorizations.

Results with Verata

Surgical Coordinators saw a substantial reduction of prior authorization burden. In a survey of BSSC staff, 100% of respondents reported time savings with the new process. With artificial intelligence-augmented prior authorizations, 75% of staff saw fewer denials that required peer-to-peer reviews, freeing up valuable time for staff members to focus on patient care. Most importantly, patients benefited, too. 100% of staff reported that turnaround times of prior authorizations were faster, giving patients better access to care and much-needed peace of mind, instead of having to wait for approvals.

“Surgical Coordinators are spending less time on prior authorizations. Since implementing Verata, we’ve been able to scale our practice.”

– Fran Helms, Business Manager

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