Sommer Bockerstette, Pre-Access Director at St. Elizabeth, discusses how looking at data around preauthorization denials and sharing cross-department insights a little differently is helping the organization better protect revenue.
What notable project helped you reduce avoidable denials over the past year?
Sommer Bockerstette: “At St. Elizabeth, we’ve been focusing on managing our prior auth denial rate. We've done so by identifying our denial root causes, working with our denial team to map root causes that pinpoint the more specific reasons for the prior authorization denial. Those root causes have enabled us to create a dashboard that helps dig into the denial data a little deeper, and the dashboard is based on where the work is being performed rather than focusing on the service line it's for.
“And so having that dashboard has allowed us to create a monthly accountability group where each centralized and decentralized prior auth group comes together to review their data, discuss action plans, and share challenges that we all might be experiencing. A lot of the times, we're solving for the same problems, just in different departments. So being able to come together to share our efforts and come up with single solutions at the system level has been beneficial.
“We've also been able to use that data to really look at our performance as a system a little differently since we do have some decentralized departments. We can now look at the work that's being performed to decide where our structure is working for us and where it might not be working for us.”
