• Seven strategies for beating the prior authorization blues

    Delays in care due to prior authorization can affect patient outcomes. Here’s a list of ways to speed up the approval process and prevent insurers and other payers from causing harm.

    1. Identify cheaper alternatives (including generics) to any expensive drugs you routinely prescribe. They’re less likely to require prior authorization.

    2. Create lists of medications and procedures that you know require prior authorization, broken down by insurer. Some EHRs can be programmed to send you an alert when you order something on the list.

    3. If you’re ordering something that you know doesn’t fit within most standard guidelines, add more documentation explaining why it’s justified.

    4. Designate a staff “expert” to handle prior authorization requests. Someone who is well-versed in prior authorization requirements (or can get up to speed quickly) can keep the process moving smoothly.

    5. Keep track (or have your staff expert keep track) of each payer’s deadlines for processing prior authorizations and appeals. Hold them to their word.

    6. Leverage technology. Fill out prior authorization documents and submit them online whenever possible, as opposed to over the phone or via the mail.

    7. Ask to speak to the payer’s medical director. Addressing prior authorizations peer-to-peer can be faster than going through standard processes.

    If all else fails, fight. Consider composing form letters that document the dangers inherent in changing patients’ drug regimens and inform insurers that you plan to bill them for the time you spend on their prior authorizations.

    For more information, see this prior authorization practice hack video from the American Academy of Family Physicians.

    Read the full FPM article: “Beating the Prior Authorization Blues.”


    Posted on Aug 30, 2021 by FPM Editors

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