Spine PA orchestration

When a spine surgery is scheduled, pull the chart, identify the payer, generate the PA packet, submit, monitor for denial, auto-generate appeals, schedule peer-to-peer.

Joint replacement pre-op coordination

Replace the schedulers' spreadsheet. Coordinate clearance, anesthesia consult, NPO, DME delivery, transport, day-of confirmation. 12 touchpoints per case.

Post-op clinical pathway

Voice-driven post-op check-ins at days 1/7/14/30/90 with subspecialty-specific questions. Captures structured outcomes for bundled payment compliance.

Referring physician nurture

Auto-generate post-op letters to referring PCPs. Voice-call referrers at 30 days with patient outcomes. Detect cadence drops and queue an outreach call.

Revenue integrity

Audit every surgical claim before submission. Verify CPT, modifiers, implant docs. Auto-file appeals on denials. Track recovery rate by payer.

Room Rounds — post-op floor check-in

Nurse selects a patient room, completes a structured survey (pain, mobility, wound, nausea), and Ohtari auto-escalates to the surgeon's nurse if any threshold is met.

Inpatient discharge coordination

When a patient is cleared for discharge, coordinate home health referral, PT scripts, follow-up scheduling, discharge instructions, and DME pickup — all before the patient leaves the floor.

New patient intake — referral to consult

When a referral arrives by fax or EHR message, classify it, create the chart, schedule the consult, send a welcome packet, and notify the referring physician — all before staff touch it.

Pre-op patient education call

7 days before surgery, Ohtari calls the patient, walks through prep instructions, confirms transport and DME delivery, collects any last questions, and flags anything that could delay the case.

CJR bundled payment outcomes tracker

Capture structured outcome data at 30 and 90 days post-joint-replacement, calculate shared savings eligibility, and generate the quarterly CMS submission report automatically.

Payer contract rate audit

Monthly audit of allowed amounts vs. contracted rates by CPT and payer. Flags under-reimbursed procedures, identifies renegotiation targets, and generates a recovery action list for the biller.

Patient inbound call · voice agent + Skills

When a patient calls, Ohtari answers as a voice agent, identifies them via Athena, and routes to the right Skill — Spine PA, Pre-op coordination, or Billing question — each with its own knowledge base. Transfers to staff with full context if needed.

Post-op complication · Clinical + Billing + Charting

When a post-op round flags a complication, Ohtari coordinates across all three teams: schedules the wound culture (clinical), stubs the complication CPT (billing), writes the op-report addendum (charting), and routes the bundle for sign-off.

Pathology results follow-up · GI

When a path result arrives, route by findings: normal → letter, polyp → surveillance schedule, dysplasia/cancer → urgent MD call. Every patient hears back, every recall is on the calendar.

Bowel prep coordination · GI

Two weeks before a colonoscopy, coordinate anticoagulant pause, diet instructions, day-before prep, day-of pickup, and same-day check-in. Reduces no-shows and incomplete preps.

Surveillance recall · GI

Automated outreach for patients due for their next surveillance colonoscopy (3/5/10 year). Books, confirms, and tracks recall rate as a revenue driver.

MIPS quality measure capture · GI

Captures adenoma detection rate, withdrawal time, and cecal intubation rate per endoscopist per procedure. Closes documentation gaps before submission.

MDS assessment coordination · SNF

Coordinates the 5-day / 14-day / 30-day / 90-day MDS windows across nursing, social work, therapy, and dietary. Ensures every section completes before the lock date. Drives PDPM accuracy.

Hospital-to-SNF admission intake · SNF

Pulls records from the discharging hospital, verifies skilled criteria, schedules family intro, coordinates med rec + therapy eval + initial care plan. Beds filled with fewer 24-hour scrambles.

30-day readmission risk · SNF

Continuous risk score for each resident in their first 30 days. Triggers extra clinical attention when risk indicators stack up — falls, wound issues, behavior changes, vitals trending. Drives readmit rate down.

Family weekly updates · SNF

Weekly summary call to each resident's designated family contact. Captures concerns, surfaces care plan questions, logs to the resident chart. Improves satisfaction + reduces unscheduled inquiries.

CMS survey readiness · SNF

Continuous audit of documentation, staffing ratios, and care plan currency against CMS F-tags. Flags risks before the unannounced survey arrives.

PROM collection · post-op outcomes

Collect patient-reported outcomes at days 30 / 60 / 90 post-op. Voice agent calls the patient; for patients already in clinic, an NFC kiosk picks them up. Concerning scores escalate to the surgeon's nurse and write to the chart for CJR compliance.