prior-authorization woes

[powermd]

Like most of you, our practice is increasingly burdened with prior-auth requirements.

It sucks, but it's one thing when you are getting prior auth for a procedure you will be paid to do. It's entirely another when I have a staff member spending 20-30 minutes on the phone to get an MRI authorized for which we will be paid nothing, and someone else will make hundreds to thousands. When you translate staff time into our cost, we're looking at spending probably $15-20 per MRI for prior auth. The only reason we tolerate this is that these are sunk costs. I'm already paying these staff members to be in the office and do other work. But it takes away from more productive and rewarding work.

Do any of you have a more creative approach to this problem?

Do any of you outsource prior-auths? There are companies that say they can do all the legwork for you at a reasonable cost.

Do any of you push it all back on the patient?

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[Dr. Ice]

Yes this sucks. It's the never ending struggle of balancing efficiency and overhead cost. There's no great solution. Outsourcing sounds interesting although the challenge I see is a lot of "middle man-ing" So third party company gets auth then what? They contact patient? They send back to you with auth and then you contact patient? I don't have the luxury of putting anything on the patient because the out of network guys down the street who get paid way more per patient encounter to do whatever have an abundance of ancillary staff who are paid better and are more skilled at getting auth, will do it for the patient. Daily struggle. Maybe the answer is join the out of network guys

 

[lobelsteve]

I have a referral for cancer pain in an addict on suboxone. Called her addictionologist prior to scheduling her an appt.

Left vm. The message says $25 fee for any rx not at office visit. Would def cut bacl on calls. Implement and charge $25 for prior auth as well.

 

[VA Hopeful Dr]

Like most of you, our practice is increasingly burdened with prior-auth requirements.

It sucks, but it's one thing when you are getting prior auth for a procedure you will be paid to do. It's entirely another when I have a staff member spending 20-30 minutes on the phone to get an MRI authorized for which we will be paid nothing, and someone else will make hundreds to thousands. When you translate staff time into our cost, we're looking at spending probably $15-20 per MRI for prior auth. The only reason we tolerate this is that these are sunk costs. I'm already paying these staff members to be in the office and do other work. But it takes away from more productive and rewarding work.

Do any of you have a more creative approach to this problem?

Do any of you outsource prior-auths? There are companies that say they can do all the legwork for you at a reasonable cost.

Do any of you push it all back on the patient?

The Imaging place I use here in town is freestanding and they do all of the prior authorizations for you, it's how they compete with the hospital system Radiology centers.

 

[hyperalgesia]

In my area as well, most of the MRI places will do the pre-auth. It's still a pain, you have to fax notes to them and wait for things to happen.

 

[painfree23]

The Imaging place I use here in town is freestanding and they do all of the prior authorizations for you, it's how they compete with the hospital system Radiology centers.

I don't get how they do this? Do they have a doctor on site that decides the medical necessity and signs off on it?

 

[VA Hopeful Dr]

I don't get how they do this? Do they have a doctor on site that decides the medical necessity and signs off on it?

My guess is that they use my order form which has the diagnosis and my signature stating is medically necessary, and then they just do all the paperwork end of it.

Every so often I will get a request for the office note to justify the order, but that's less than 10% of the time.