Prior authorization denials are a major issue in the field of rheumatology, leading to delays in treatment and increased costs for patients. While many of these denials are necessary to ensure that medically necessary treatments are provided, others can be avoided with the proper steps. Let’s discuss strategies for reducing prior authorization denials in rheumatology, from improving communication to leveraging technology.
The first step to reducing prior authorization denials is to improve communication. Many denials are the result of incomplete or incorrect information from either the patient or the healthcare practitioner. To help ensure accurate and complete information, rheumatologists should take the time to review a patient’s medical records and discuss their treatment plan with the patient. This can help to ensure that the patient understands the risks and benefits of any proposed treatments and that the provider has a clear understanding of the patient’s needs. Additionally, providers should make sure that they are accurately documenting any treatments prescribed and that they are providing the necessary documentation to insurers in a timely fashion.
The second step to reducing prior authorization denials is to leverage technology. Utilizing technology and allowing automated workflow to take over some of the tasks in the insurance approval process can eliminate a lot of this burden. The ID to IV process is largely manual and relies heavily on outdated communication methods such as multiple phone calls, faxes, emails, and manual tracking. Through IT advances, specifically software development and market research, it’s been found that many of the steps in the process can be automated, accelerating the speed to therapy with near-instant benefits investigation to start the process and cutting time to prior authorization by up to six weeks.
Benefits investigation and prior authorization naturally lend themselves to digital solutions. Collecting necessary patient information and submitting needed forms to Hubs and payer portals digitally cuts many of the manual steps out of the process. Integrations built between touch points throughout the process allow technology to easily take over, eliminating practice personnel’s need for monotonous steps. Software such as eBlu Solutions allows BI’s and BV’s to return in 60 seconds or less for nearly 77% of the cases*. This “real-time response” allows the HCP and the patient to feel more secure in their decision-making regarding treatment so they can move forward with peace of mind for payment and reimbursement.
Additionally, such software can provide additional visibility and insights for stakeholders regarding reporting. Centralized platforms with data dashboards and PA tracking allow the HCP, manufacturers, and payers to better understand the patient journey and treatment adherence. Such transparency provides a unique gateway to further optimizing the healthcare ecosystem to ensure there are fewer obstacles for current and future patients.
The third step to reducing prior authorization denials is to take advantage of resources. Many insurers have established programs to help streamline the prior authorization process. For example, some insurers offer programs that allow providers to submit prior authorization requests electronically, which can help to ensure that requests are completed correctly and quickly. Additionally, insurers may have dedicated teams of experts to help answer questions and resolve any issues that arise. Taking advantage of these resources can help to reduce prior authorization denials and ensure that patients receive the treatments they need in a timely manner.
Finally, providers should stay up to date on any changes to prior authorization requirements. It is important to remember that prior authorization requirements can change from year to year, as can the insurers’ policies and procedures. Staying abreast of these changes can help providers to better understand the requirements and ensure that they are submitting prior authorization requests correctly. By taking these steps, rheumatologists can reduce the number of prior authorization denials they face, leading to better outcomes for their patients. Improved communication, leveraging technology, taking advantage of resources, and staying up to date on changes can all help to ensure that patients receive the treatments they need in a timely manner.
