Regional Medical Center Solves Prior Authorization With Artificial Intelligence & Increases Monthly Revenue by 13-25%

Verata’s Frictionless Prior Authorization® helps Watertown Regional Medical Center decrease patient wait times for prior authorizations and dramatically increase procedural volume and revenue across multiple service lines

 

Background

Watertown Regional Medical Center (WRMC) is a full-service general hospital and Level 3 Trauma Center located in Watertown, Wisconsin, just east of Madison. WRMC has a partnership with LifePoint Health, a comprehensive health network with over 90 partner facilities and practices spanning across the United States.

Challenge

A series of staffing shortages left a major prior authorization backlog at Watertown Regional Medical Center. The hospital was struggling to keep its clinics filled and their patients cared for.  Slow turnaround times clogged patient throughput, leaving idle scanners, empty ORs, and frustrated patients. With turnaround times nearing 15 business days to complete some prior authorizations, patients were left in limbo for weeks, and any last-minute cancellations were impossible to fill—leaving provider schedules empty and revenue left on the table.

Results with Verata

Watertown Regional Medical Center saw significant improvements with Verata’s AI platform. Now that prior authorizations are automatically prepared, WRMC has cut prior authorization turnaround times by 60%. The faster turnaround on prior authorizations meant that procedural clinics no longer schedule patients 15 days out – they are now able to accommodate patients more quickly.

Automating prior authorizations also reduced missed prior authorizations or errors in prior authorization coding. The result was a 32% year-over-year reduction in write-offs across every department using Verata.

In a year-over-year analysis of departmental revenue, every Verata service line saw between a 13% and 25% increase in monthly revenue following Verata implementation, which translated into more than a $3M increase in annual revenue with Verata.

“Prior authorization was taking clinical staff away from patient care and severely impacting our bottom line. Verata met – and exceeded – all of our expectations.”

– Jim Bird, Chief Financial Officer

Interested in the full case study? Submit your information, and we will send you the full case study