New AAFP Resources Can Help Streamline Prior Authorizations

Earlier this summer, the Academy launched an Administrative Simplification hub that highlights the organization’s ongoing work to cut through the administrative obstacles that family physicians regularly encounter in their practices.

The July/August issue of FPM, for example, is largely devoted to administrative simplification, with how-to articles contributed by family physicians on a range of related topics, including “Practical Ways to Manage Your EHR Inbox,” “FMLA Does Not Need to Be a Four-Letter Word” and “A Step-by-Step Time-Saving Approach to Coding Office Visits.”

The AAFP Innovation Lab’s work with partners Suki and Navina also stands as testament to the Academy’s commitment to identifying solutions that have been shown to reduce the time practicing FPs spend on documentation, as well as enabling them to optimize diagnosis and ICD coding processes, thus potentially boosting practice revenues.

On the advocacy front, the AAFP has long supported industry-wide administrative simplification aimed at reducing health care costs by strengthening the electronic exchange of data and removing barriers that plague the compliance, claims and billing processes. Earlier this month, in fact, the Academy outlined these and other goals in comments to CMS on the 2022 Medicare physician fee schedule proposed rule.

On a more granular scale, because Academy members have consistently singled out prior authorizations as an especially burdensome area of medical practice, the AAFP has concentrated a considerable amount of effort on working toward the elimination, or at least mitigation, of this particular problem.

Just in the past week, the AAFP posted a pair of new resources intended to help members manage prior authorizations.

The first of these is a Family Medicine Practice Hack video that offers specific tips to help busy family medicine practices streamline the prior authorization process:

• have one or more dedicated staff assigned to handle this task so they’re able to develop expertise and easily implement best practices, such as submitting prior authorizations electronically;
• standardize the workflow involved in processing prior authorizations to ensure all necessary information is included for each payer, thus minimizing the likelihood of denials and the need for subsequent appeals; and
• create a prior authorization cheat sheet to help staff quickly recognize and assemble required clinical information to submit a prior authorization request.

That’s where the second new tool comes in: Members have exclusive access to a workbook template containing sample cheat sheets that practices can customize to show, for example, typical requirements and clinical indicators for the medications and services that most commonly require prior authorization for each insurance company with which they work.