How improving prior authorization helps your patients, referring physicians, and your imaging practice

Imaging Specialists of Charleston, a radiologist-owned, full-service medical imaging center in a South Carolina suburb faces stiff competition in its region, specifically from a trio of hospital-based imaging providers.

But the imaging center has stepped up to the challenge since opening in 2008 by focusing on the people they serve, according to director Vicki Richter. “It’s become very competitive for us, but we continue to grow because of our pricing structure and customer service.”

Customer service of course means keeping patients happy, but for imaging providers, that also includes referring physicians. In an effort to help add value to those referrers, the staff at Imaging Specialists hoped to take on some of the burden of prior authorization, and in the process preserve—and grow—their referral numbers.

Most of Imaging Specialists’ customers are covered by BlueCross BlueShield of South Carolina, which runs its authorization through National Imaging Associates (NIA), explains Richter. All high-end imaging at outpatient centers requires authorization first be obtained by the referrers, but this can cause issues.

“[Referring offices] are busy,” says Richter. “They don’t want to stop what they’re doing to get us authorization to perform the exam that we’re going to get paid for.”

To complicate matters, hospital-based imaging facilities don’t require that same authorization, making it easier for referring physicians to just send their patients to one of the local medical centers.

Imaging Specialists hoped to help their busy referral partners while protecting their own flow of patients by offering to obtain authorization themselves, but in 2014, NIA requested that the imaging center no longer use this strategy and instead leave the task up to the referring offices.

Helping hand

A solution materialized when Merge, the vendor that supplied Imaging Specialists’ radiology information system (RIS) and a host of other imaging services, announced it was launching a new prior-authorization system. Part of Merge’s iConnect® Network Services, iCNS Authorize automates the imaging prior-authorization process. Any exams that require authorization are automatically sent to a work queue with the Merge team.

To prove out the system, Imaging Specialists started slowly; Richter says when they went live with the service in June, the iCNS Authorize team was only handling MRI exams for one smaller carrier. After seeing there were no denials during this initial phase, Imaging Specialists quickly ramped up their use of the system and by three months, all high-end imaging authorizations were being processed using iCNS Authorize, and there have been no denials since.

Richter says the integration was seamless and that communication with the authorization team is great. While most scans are scheduled days in advance, there are certain add-on cases that require a quicker turnaround, and the iCNS Authorize service allows for cases to be classified by their urgency.

“Once we add a patient, [Merge] can get the authorization today, even within the hour,” says Richter.

The center’s referring physicians are generally relieved to eliminate the burden of authorization resting on their offices. The platform is also unique because it keeps these physicians in the loop if they use the iCNS physician portal for ordering exams. 

Both Imaging Specialists and their patients benefit from this service as well. Richter says many patients in the area have high-deductible coverage. If referrers send patients to the hospital for their imaging, where the same quality of scan can cost three times what it does at Imaging Specialists, the extra expenses come right out of patients’ pockets—and the imaging center’s bottom line.

Additionally, the new system helps solve some tricky issues that had plagued the practice. Claims denials are a serious issue across the country, with more than 80 percent of denials nationally stemming from a lack of prior authorization or related issue. Richter says there would be instances under the old system where a referrer failed to get authorization by the date of the scan, and the imaging center would be forced to reschedule to avoid a claims denial. Now, Richter says, the reschedule rate has dropped at least 10 percent.

Richter also notes that the practice is now able to spend less on human resources as a result of the new authorization system. Because of Imaging Specialists’ commitment to customer service, the practice began to see the patient base grow. Two staff members would verify authorizations before a patient arrived in addition to other scheduling duties, but the growth in patient numbers was going to require the hiring of a third staff member for these tasks. Richter says the new authorization service negated the need for this additional expense.

Imaging Specialists continues to grow, and Richter credits the steady communication with the Merge authorization team for helping the practice best serve its patients. “Their customer service is just what we needed to maintain our customer service.”