The vast majority of people are awaiting DME prior authorizations, causing treatment delays. As a result, it is critical to obtain patient prior authorizations as quickly as possible in order for you to be compensated and your patients to receive the therapy they require.
The fact of the matter is that you can begin reducing your prior authorization load by organizing your workflow around building connections, improving accuracy, and being diligent. Here are some creative suggestions to assist you to expedite the approval of DME prior authorizations.
Choose an Expert
Considering how much time your staff spends on pre-certifications, it essentially puts someone unskilled in charge of distributing the task to a wide number of personnel. Instead, hire someone with experience in this discipline, or delegate responsibility for the surgery in your clinic.
Provide them with whatever tools they believe they will need to document the process and maintain payer standards up to date on a regular basis. Allow them to focus solely on obtaining DME prior authorizations. Assist them in building a project plan to ensure that they communicate closely with each application and denial in order to keep the process moving forward.
Take command by compiling a master list of medications and treatments that require DME prior authorization, as defined by the insurance. Then, remind all of your clinicians to review DME prior authorization processes before administering treatments or passing prescriptions to pharmacists.
Submit a complaint
Any physician in your clinic should be taught how to write a succinct, well-articulated medical necessity appeal by your DME prior authorization specialist. 94% of the time, the specialist can gather enough information to compel a successful appeal. However, the remaining 5% – 6% may demand the participation of a health care provider. The expert can provide whatever assistance is required, such as an outline to follow and important details to add.
Embracing technology is the best way to make the most progress on this difficult task. The authorization procedure can be significantly accelerated by switching from faxes and phone calls to digital communication.
DME Prior authorization software is available to reduce labor time and boost efficiency when acquiring prior authorizations. Practices that use precertification as their primary technique claim a 94% reduction in work volume on average. Even the research suggests a 50% cost savings, which can be utilized elsewhere. Furthermore, clinics that receive a high volume of routine DME pre authorizations can save up to five times their cost.
Hence to summarize, it is essential to adhere to the principles stated above if you really want to make the DME prior authorization approach faster and simpler. It not only saves time, but it also saves money.