Automated telephonic tool reduces pre-cert hassles

Time staff spend on hold slashed dramatically

An authorization system recently implemented at the University Hospital of Arkansas in Little Rock is on track to streamline the pre-certification process and reduce payer denials, explains Holly Hiryak, RN, CHAM, director of hospital admissions.

VoiCert, an automated, telephonic tool for obtaining authorization from payers for admissions, outpatient procedures, and ancillary services, waits on hold so registrars don’t have to, combines multiple pre-cert requests into one telephone call, and provides documentation of authorization history, Hiryak adds. "We have so many access points throughout the system where it’s difficult for registrars to sit on hold for 15 or 20 minutes" waiting to get authorization for a procedure, she notes. "Patients walk up, a physician needs you to do something, another phone is ringing — that’s the reality when you have multiple clinics and a lot of different people trying to do the [pre-cert] work," she notes.

What sometimes happens, Hiryak says, is that people hang up to take care of other duties and forget to call the payer back, and the hospital ends up providing a service free of charge. With VoiCert, she explains, the automated process works like this:

1. The registrar calls VoiCert and speaks the preliminary demographic and clinical information into the phone, hanging up when finished.

2. VoiCert calls the payer and waits in the holding queue for the payer representative to answer. Once contact is made, the payer representative listens to the demographic and clinical data and then records the authorization information. The representative also can record a request for additional information or connect directly with the provider for a discussion about a difficult case.

3. VoiCert delivers the authorization information to the registrar or to a prespecified voice mailbox. The information is stored permanently for future retrieval.

The system requires an average of 2.5 minutes of phone time per certification, she notes, and pre-certification requests can be entered sequentially to multiple payers during one phone session. Each payer may need slightly different information, but the way the prompt is set up, the person making the call doesn’t have to know those differences, Hiryak says. While not all of the hospital’s payers are on the VoiCert system, she adds, the vendor works with the managed care staff, and does whatever is necessary to get payers set up.

What is the incentive for the payers? "They’re graded based on calls received, wait time, and dropped calls," Hiryak points out. "This helps them get a better satisfaction rating."

"It’s a pretty nifty tool," she says. "[Registrars] really like it. They get excited when they get that call back [with the authorization]. The good part is that all of this is recorded, so if a payer says, We didn’t tell you that you didn’t need a pre-cept,’ we can play the recording back for them. We can overturn denials."

The ability to monitor calls came in handy soon after implementation, during a holiday weekend when there also was inclement weather, Hiryak notes. "One of the payers’ voice mailbox was full, so we could not call in a notification. We now have the recording of the message saying that the box was full, so if the payer tries to deny, we have voice documentation that their system could not accommodate us," she adds.

The system also has the capability of recording outbound calls even if the registrar is on the line with a payer that is not on VoiCert, Hiryak explains. "It announces to the payer that you will be recording the information. So again, if the payer comes back [disputing a pre-cert], you can play the recording," she points out.

Although the system is simple and easy to use, she notes, the vendor provides a "great implementation guide. They very much engage themselves with you to make sure [the tool] is meeting your needs and goals."

[Editor’s note: Holly Hiryak can be reached at (501) 686-8170 or by e-mail at hiryakhollym@uams.edu.]