The Smart Medical Practice

7 Ways to Speed Up The Prior Authorization Process


AMA Study Shows That Behind EHR, Preauthorization is a Key Component in Physician Frustration

7 Ways to Speed Up The Prior Authorization Process

 

Obtaining preauthorization is so frustrating and time consuming that many physicians are strongly pushing for complete elimination. Since that scenario is unlikely, we’re pointing out some concrete steps physicians can take to speed up the prior authorization process, making it less costly and exasperating.

  1. Hire a prior notification star. Considering how much time your staff spends on precertifications, it makes no sense to put someone inexperienced in charge of this activity or spread the task among several people. Instead, hire someone with expertise in this area or put someone in your practice with a knack for the process in charge.Give them whatever tools they say they need to continuously document the process and update payer rules, and if you have more than one doctor, let them work on obtaining authorizations full time, without distraction. Help them set up a project management system that ensures they follow up on every request and every denial to keep things moving through the process.
  2. Don’t fight city hall. Instead of railing against the convoluted process, get proactive by creating master lists of medication and procedures that require prior auth, broken down by insurer. Then, instruct all of your clinicians to check preauthorization requirements before providing services or sending prescriptions to the pharmacy.
  3. Get your ducks in a row. The key to getting authorizations right the first time is submitting a complete request backed up by well-document data. Taking shortcuts at this stage will only get you a denial, after which you’ll have to gather/write up the documentation the way it should have been submitted in the first place. Use our handy toolkit checklist to make certain all necessary data points are obtained.
  4. Get ready to appeal. Your authorization specialist should train every clinician in your practice on how to organize a concise, well-articulated appeal of medical necessity. 94% of the time, the specialist can gather enough material to force a successful appeal, but the other percent may require the health care provider. Here, the specialist can provide whatever guidance is needed, including an outline to follow and key elements to include.
  5. Save time: go peer-to-peer. Having a physician get on the phone with a payer should certainly not be the first option, but there are times when a five-minute phone call between a physician and the insurer’s medical director can save hours of staff time trying to fix an authorization gone wrong. When it comes down to fail-first step therapy, often it is only the doctor who can argue necessity.
  6. Be ready to make deals. Some insurers are willing to work with practices to create pre-approved deals on precertification. Generally speaking, you tell the payer that if a patient presents with a condition, you will follow a specific treatment plan and ask blanket approval for that cause/effect. Doctors under contract for population health argue zero authorizations required based on the fact that the provider is partnering to carrying the risk.
  7. Embrace technology. Embracing technology is the fastest way to make the greatest improvement with this difficult problem. Moving away from faxing and phone calls to digital communication can greatly speed up the authorization process. Electronic prior authorization software is available to ease the work load and increase the efficiency of obtaining prior auths. On average, practices who’s primary method of obtaining precertification, report a 94% reduction in workload, and a 50% reduction in cost––money that certainly be put to better use elsewhere. And practices that have a lot of mundane auths can experience a cost saving of a factor of as much as 5 times. Click here to calculate the savings of time and money you’d experience by moving to electronic prior authorization as your primary way of obtaining preauthorizations.

Finally, there are some useful tools on the American Medical Association website to help improve your practice’s prior notification process. They include a PDF of a presentation called “Break Through the Prior Auth Roadblock,” a comprehensive paper outlining the AMA’s recommendations called “Prior Auth: The Current Landscape,” and a shorter version called “Tips to Help Physicians Reduce the Preauthorization Burden in Their Practice.”

Sources:

  1. “Prior Auth Frustration,” Physicians Practice, February 13, 2018, //www.physicianspractice.com/physician-productivity/prior-authorization-frustration
  2. “Beating the Prior Auth Blues,” FPM, Sept/Oct 2016, //www.aafp.org/fpm/2016/0900/p15.html
  3. “3 Ways to Outsmart Prior Auth Ploys,” TCI Blog, September 15, 2017, //www.aafp.org/fpm/2016/0900/p15.html
  4. “5 Tips to Minimize Authorization Delays, AMA Wire, January 2, 2016, //wire.ama-assn.org/practice-management/5-tips-minimize-prior-authorization-delays

 


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