Administrative tasks burden today's physicians more than ever before. Obtaining prior authorizations for tests and treatments from payers is one of the leading productivity zappers, an activity which the nation's physicians spend 868.4 million hours per year, according to a recent article from Medical Economics.
Short of giving up insurance contracts, there is little practices can do to free themselves of this burden, experts said. However, they recommended the following ways to reduce the time and expense associated with prior authorizations:
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Know what the payer requires in advance. "Being aware of what will require prior authorization, and making sure that you've already tried the cheaper meds or whatever the requirements are is really important," Kevin de Regnier, D.O., a solo family practitioner in Winterset, Iowa, told Medical Economics. "That way, when you do get to the point where you have to request the prior auth, you're less likely to get it rejected because you didn't try something or didn't include the right piece of information."
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Tailor your electronic health records (EHR) to help. "If we know that a particular plan will require trying physical therapy before approving surgery, and we don't have any physical therapy in the documentation, then the EHR will send a warning, 'this request may fail, please indicate why physical therapy is contraindicated,'" said Mona Reimers, Ortho NorthEast's director of revenue services.
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When in doubt, use the phone. While payer websites make it convenient for medical practice staff to obtain information and submit prior authorization requests, electronic submissions risk getting lost with no possibility of follow-up, according to Sherry Hughes, one of de Regnier's employees. "We find it works a lot better on the phone. It takes longer, but you're talking to a person and they can tell you right away if there's any additional information they need. It really expedites the process."
To learn more:
- read the article