These insider tips can save you time by putting your imaging requests on the path to easier approval.
Fam Pract Manag. 2024;31(1):7-11
Author disclosures: no relevant financial relationships.
Prior authorizations continually rank as one of the top administrative burdens on physicians.1 While they can be a hassle, and are perhaps used for too many medications and procedures, prior authorizations are an important tool for managing advanced imaging, which is one of the leading causes of high health care costs in the U.S.2
As a radiology benefits management clinical reviewer and a supervisor of reviewers, we would like to share some tips to help our fellow physicians avoid that dreaded peer-to-peer call request, prevent clinical denials, and generally make prior authorizations less burdensome.
KEY POINTS
Prior authorization is burdensome to physicians, but it’s an important tool for managing expensive imaging studies and can be easier if physicians and their staff follow a few key tips.
Common reasons for denials include unsent or incomplete documentation, another clinician ordering the same test, and ordering the wrong type of test (e.g., CT vs. MRI).
To ease your prior authorization burden, leverage your team, make sure you’ve included proper documentation for specific studies, and consider alternatives to imaging.
COMMON REASONS FOR DENIALS
There is often a simple explanation as to why the study you ordered for your patient didn’t get approved. Here’s what can go wrong and how to prevent it.
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