DME Prior authorizations, also known as prior approvals, are measures used by payers to manage costs and ensure that their members receive only medically necessary care. Before providing specified services or commodities to a patient, providers must obtain advance approval from payers under the cost-control process.
DME Prior authorizations are progressively being used by payers to save costs and improve treatment quality for their members. However, gaining prior clearance for services imposes tremendous costs on providers.
According to a recent poll conducted by the Medical Group Management Association (MGMA), 86% of providers reported that DME PA requirements have increased in the last year. Another 82% of providers in a new MGMA study named the pre-approval process as their most significant regulatory costs.
Prior authorizations, according to around 92% of respondents, also delay patient access to therapy. Moreover, 78% have said that DME prior permissions can occasionally, frequently, or always result in patient non-adherence to a course of treatment.
DME Prior authorizations can be significant administrative costs for providers. However, payers see cost-cutting as a crucial goal, resulting in increased prior authorization utilization. Providers can reduce the stress of dealing with previous authorizations by automating the process, proactively reviewing requirements, and delegating prior approvals to personnel.
Method 1: Automated DME Prior Authorization
Using automated or electronic prior approvals can help to streamline the process and eliminate errors. DME PA that is entirely electronic can also save providers time and money. According to the CAQH Index, manual HME/DME prior authorization cost providers $5.75 per request and takes 14-20 minutes of staff time. Electronic transactions, on the other hand, can save providers a total of $245 million and between seven and nine minutes every transaction.
Providers should also inquire with their payers about whether they accept conventional prior authorization transactions until electronic DME PA is approved. Providers may have to conduct specific manual prior authorizations for certain payers.
Implementing electronic prior authorization solutions will give providers instant financial and clinical advantages till technology evolves and stakeholders adopt national standards.
Method 2: Verify the Specifications Required
DME Prior authorizations, according to the vast majority of physicians, impede patient access to care. Before beginning a treatment course, providers frequently have to wait for payers to obtain and approve prior permissions. Payers may also refuse to pay for services or prescriptions, forcing providers to spend time and resources submitting more documentation or filing an appeal.
Providers may not be able to influence payer decisions on DME prior authorizations or the speed with which insurance decide on a case. They can, however, establish a proactive strategy to avoid care delays. Check the requirements for DME PA before providing services or submitting prescriptions to a pharmacy. Making sure a previous clearance is required and what is required for payer approval will help reduce medical service claim denials and lost payments. As well as ensuring pharmacies can fill prescriptions on time to avoid medication non-adherence.
Method 3: Complete Organizational Workflow
Physicians and other providers of care are particularly irritated by the administrative hurdles associated with DME prior authorization. Prior clearances for services and prescriptions, according to providers, are regulatory costs that delays patient access to care and create unneeded work. Transferring responsibility for prior authorizations to a specialized staff could help to decrease the stress on care delivery providers while increasing productivity.
Hence to summarize, DME Prior authorizations are a time-consuming administrative task for providers and their personnel. DME Prior authorization technology for medical services lags and payers are simply beefing up their prior authorization systems to save costs. As the sector refines its usage of the cost-cutting technique, providers should be assessing needs on a regular basis, allocating prior authorizations to a staff member, and utilizing technology to avoid major pain points.