Techniques to reduce prior authorization burden
Prior authorization can eat up valuable time better spent on patient care. Here's how to fix that.
The Academy is committed to identifying techniques to help reduce—even eliminate—your prior authorization burden without compromising patient care. Techniques for successfully navigating payers’ prior authorization requirements can be categorized into three primary areas.
- Techniques on this page:
- Prescribe mindfully
- Streamline & delegate
- Push payers
Technique 1: Prescribe mindfully
Family physicians and their staffs have set up systems to try and order cheaper, evidence-based drugs, tests and treatments that do not require prior authorization. Each prior authorization carries the burden of time, effort and delay, so any that can be avoided in the first place will prevent associated downstream burdens.
Ways to implement:
Identify safe but cheaper alternatives to high-cost drugs
Prescribe based on evidence-based guidelines
Choose generic drugs when possible
FPM: 13 ways to reduce prior authorization burden
Technique 2: Streamline and delegate
Practices have built rules and cheat sheets into their electronic health records (EHRs) and workflows to help address prior authorization requirements. They have delegated prior authorization to dedicated staff, freeing others to focus on care. You can use your team and EHR to your advantage.
Steps to follow:
Create master lists of medications and procedures that require prior authorization and program your EHR to alert you when you order something from these lists.
Be especially thorough with documentation when ordering treatments or services you know do not follow standard guidelines.
Create prepopulated forms, ideally using the insurer’s own listing codes, diagnoses and other information typically required to process a prior authorization.
Submit requests electronically and use technology (a portal or EHR) to upload supporting documentation instead of faxing it.
Designate one or more dedicated staff to submit prior authorizations.
Technique 3: Push payers
Family physicians and their staffs have successfully used the appeals process and direct communications to push payers for fewer prior authorizations and faster processing. Physicians can also educate their patients to direct their frustrations with delayed treatment at payers rather than the practice.
Tips to consider:
Demand that deadlines be met. Push insurers to meet their own deadlines for turning around prior authorization requests.
Use the appeals process. If denied, use the payer’s appeals process. Keep track of appeals and how long until an insurer must make a decision.
Talk to the payer’s physicians. Leverage a payer’s peer-to-peer process to clear up prior authorization problems much faster.
When all else fails, fight. Write a letter to the insurer standing up for your patient. Bill the insurer for your time. Contact your state insurance commissioner.
