The majority of patients are waiting for DME prior authorizations, which is harming their care. That is why you must obtain patient DME prior authorizations as soon as possible – so you can be reimbursed and your clients can receive the care they require.
The good news is that by organizing your workflow with an emphasis on developing relationships, enhancing accuracy, and being diligent, you may lessen your DME prior authorization load. Here are 5 pointers to assist you to get those DME prior authorizations issued as soon as possible.
Avert treatment discontinuation
Seeking DME prior authorization for a patient service is more than a procedure; it is a practice that has a significant impact on the person’s condition. According to the 2017 AMA DME Prior Authorization Physician Survey, 64% of physicians waited for at least one business day for a DME prior authorization judgment from a patient’s health plan in a week’s time.
30% waited at least 3 business days. Furthermore, 92% of physicians stated that the process does delay access to medical care. 78% stated that these delays frequently result in treatment abandonment, and 92% stated that the process can have a detrimental influence on patient outcomes.
Optimize Your PMS and EMR Systems
You’re probably spending a lot of money on your Practice Management Systems (PMS) and Electronic Medical Records (EMR) systems, so make the most of them. Work with your PMS/EMR vendors to create the management reports you’ll need to track and improve the efficiency of your DME prior authorization procedure. Use it to develop workflows that have no room for error.
When authorizations are necessary, and when they are received, your management reports should show this. Use other resources provided by your PMS/EMR vendor, including user groups and conferences. User groups are a terrific method to connect with other users and administrators who may have solutions you haven’t tried before. Attending conferences provides an excellent opportunity to communicate with your vendors about your requirements.
Enhance Intake Efficiency
Patient intake is frequently the root cause of missing DME prior authorization, so all information collected for prior authorization must be correct. Make sure you use the same spelling for the patient’s name and address on the DME prior authorization as you do in your systems.
Many PMS and EMR programs copy subscriber data from the customer. Instruct your screening team so that they understand the ins and outs of the providers.
Establish Positive Associations
The provider representative serves as a liaison between the insurance company and your medical practice, explaining coverage, verifying benefits, and ensuring a positive connection between you and their specific insurance company. That means it’s their business to retain you in their network; take advantage of this. Get to know your representative. Inform them of your difficulties with the DME prior authorization process.
While payers see the DME prior authorization process as an efficient way to evaluate the medical necessity and choose the most cost-effective treatment plan for the patient, you may be disappointed by how time-consuming it can be to secure these approvals and navigate the system.
Know and Track Your Payer’s Guidelines
Policies vary per payer, and the majority of payers post coverage-related policies online. You should be familiar with and keep track of these rules. As well as track modifications and keep copies of archived policies. If a payer is going to dispute you over a rejection, it should be with that particular year’s policy, but even they aren’t always aware of which policy is at issue.
You must be at the top of your game when it comes to DME Prior Authorization. It’s also a good idea to save copies of public newsletters, emails, and anything else payers send that’s linked to their present policy.
Key takeaways
One of the most likely causes a DME prior authorization request is postponed or denied is that crucial details are lacking. The above-mentioned points if followed will make the DME prior authorization process much faster and will enhance workflow for both parties. The sole function of these pointers is to help you prevent any sort of unnecessary delays and save time by making sure you have all of the information you need to submit a DME prior authorization request.
