How to Accelerate DME Prior Authorizations and Reimbursement?
The majority of patients are waiting for DME prior authorizations, which is delaying their care. That is why you must obtain patient DME prior authorizations as soon as possible. So you can be reimbursed and your patients 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 prior authorization load. Here are some pointers to assist you to get those DME prior authorizations issued as soon as possible.
· Prevent Treatment Cancellation
Requesting prior authorization for a patient service is more than a formality; it is a process that has a significant impact on the patient’s health. According to the 2017 AMA Survey, weekly 64% waited for at least one business day for a DME prior authorization decision from a patient’s health plan, and 30% waited at least three 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.
· Increase the Effectiveness of Your PMS and EMR Systems
You’re probably spending a lot of money on your PMS/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.
· Advise physicians on the need for paperwork
Clinicians must be educated on the patient’s DME prior authorization process. They should be aware of the patient’s insurance coverage and whom to notify if the process changes in the middle of the procedure. However, because their paperwork is so vital to the process, they should also be trained on the entire procedure.
Make sure they understand conservative treatment because insurance companies will typically want to know that conservative treatment failed before authorizing a more intrusive operation. Inform the doctors about your difficulties and provide comments.
· Work On Your Denials
Denials are inconvenient, but they can be turned into a learning opportunity. Working through your denials will assist you in avoiding them in the future. Your practice management system should include denial reports to help you determine why the denial happened in the first place.
Look for patterns in these reports to figure out what happened. Then, collaborate with your PMS/EMR vendor to design a system that makes your software work for you. Create reports, for example, that highlight combination of payers and procedures that require DME prior authorization. Discuss these reports with your team so that they stay aware of the procedures.
Hence to conclude, DME prior authorization is a complex procedure. You must have all the required software and skilled staff to make the whole process smooth. The above pointers will guide you in making the process much more valuable and efficient in the future.
