Seeking prior authorization from insurers for certain types of services is a regular headache for family physicians. However, physicians and their staff can take several steps to lessen the burden. Here are more than a dozen ideas.
1. Identify equally safe and effective but cheaper alternatives to any high-cost drugs you prescribe. This way, you won’t have to go through the prior authorization process.
2. Create master lists of medications and procedures that require prior authorization, broken down by insurer. If possible, have your staff use these lists to program your electronic health record to alert you when you order something that requires prior authorization.
3. Use evidence-based guidelines. Insurers are likely to require prior authorization for orders outside those recommendations.
4. Prescribe generic drugs when possible. These usually do not require prior authorization.
5. Educate patients about prior authorization and coverage limitations. This can reduce patients’ anger toward you for treatment delays or refusals and can help direct their complaints to their insurer, which could possibly bring about a change in insurer policies.
6. Spend more time on documentation. Specifically, do this when ordering things you know do not follow the standard guidelines.
7. Systemize the process by creating pre-populated forms. If possible, use the insurer’s own forms, listing codes, diagnoses, and other information the insurer typically requires to process a prior authorization.
8. Designate one or more staff members to handle all prior authorization requests. This can free up the physician’s time and allow the designated staff to become more knowledgeable and efficient.
9. Use technology whenever possible. This includes filling out prior authorization requests online as opposed to over the phone.
10. Push insurers to meet their own deadlines for turning around prior authorization requests.
11. If denied, use the appeals process. Make sure to keep track of appeals and how long until an insurer must make a decision.
12. Take advantage of a payer’s peer-to-peer process. Speaking to the insurer’s medical director or other physician available to speak with physicians about prior authorization issues can clear up problems much faster.
13. When all else fails, fight. Some physicians send a form letter defending their use of a particular medication or pointing out the dangers of changing patient drug regimens, while others threaten to send the insurer a bill for their time.
Read the full FPM article: “Beating the Prior Authorization Blues.”
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