Patients tend to become anxious when scheduled care is cancelled due to authorization holdups. This happened so often at Stanford Children’s Health in Palo Alto, CA, that a decision was made to change the process.
“We’ve had to go so far as to implement a policy that says, ‘If the auth is still pending, we’ll still schedule you for service,’” reports Shawn Tienken, MHA, director of revenue cycle operations at Stanford Children’s Health in Palo Alto, CA
If the payer takes too long to give an answer one way or the other, things go forward as planned anyway. Patients are responsible only for their copay, coinsurance, or deductible that they would have paid anyway.
“We tell them, ‘We won’t hold you liable if it gets denied,’” Tienken explains. Cancelling services at the last minute puts the hospital in a difficult position. “We had all the resources we put into that space that we suddenly are not able to fill,” Tienken says. “We don’t want a pre-eminent surgeon standing around with nobody to operate on.”
The revised policy takes the worry off patients, and makes scheduling more predictable. Although it is a financial risk for the organization, it is a calculated one. “We’ve got a front-end process that’s increasingly precise,” Tienken shares. “It’s a risk that we can afford to take.”
More than 90% of requests end up authorized. “If it doesn’t, our appeals process is also pretty good,” Tienken adds. The total dollars that end up written off because of denied auths are tiny compared to overall cash collection.
For registrars, changing the policy helped morale. Registrars can schedule services confidently without cautioning patients it is not a sure thing until the payer says so. Instead, they tell patients, “Assume that you are good to go. You will only hear from us about the auth if it gets denied.” To some, this sounds too good to be true. Many still worry about receiving an expensive bill if the payer ends up denying the authorization. “Our experience is that people still don’t believe us. They call us anyway, worried about whether it’s been approved yet,” Tienken observes.
Registrars assure patients there is no need to worry; the hospital is taking the risk, not the patient. For many, the prior authorization policy gives them one less thing to worry about. “The whole reason we did it was to relieve the patient’s stress — and relieve the provider’s stress,” Tienken says.