3 Ways to Adapt When it Costs More to Get Paid the Same

Rene Letourneau, for HealthLeaders Media , February 24, 2014

EIRMC is also directing its attention to increasing preauthorizations, especially for surgical procedures.

"In late 2013, we assigned a dedicated case manager to work with the OR to assist in getting preauthorizations," Baiocco says. "We're doing that ahead of time so as not to disrupt the patient case… we don't want to delay a case unnecessarily."

Although the case manager has only been working with the OR for a few months, EIRMC is already reaping the benefits.

"There are some times, for example, when a case has a very expensive supply attached to it, and that wasn't part of the preauthorization. We are tightening up the process for those kinds of instances, and we are already seeing dividends," Baiocco says.

Paying this level of attention to preauthorizations is also good for patients, he notes, even if a procedure has to be postponed for a short time.

"An elective case may be delayed by two days until we have everything worked out, but that benefits the patient, too," Baiocco says. "The patient doesn't want to be in a position where there is a denial on their coverage and now not only do they have a healthcare problem, but they also have a financial problem."

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