Medical providers frequently point to the pursuit of prior authorization as a factor contributing to clinician burnout. Let’s face it: clinicians don’t pursue medical degrees because they love doing paperwork; they want to help patients. And the frustration caused by prior authorization impacts front and back office staff too. This is particularly true when it comes to service lines that rely heavily on prior authorization. Prior authorization software can help.  

High volume services lines demand high efficiency solutions

By targeting service lines that handle high volumes of prior authorizations, even those that are relatively simple and routine, automation can yield significant benefits. So, what service lines stand to gain immediate and long-term value from moving from manual prior authorization to an automated approach?

Imaging 

When it comes to radiology, diagnostic CT scans, MRIs, PET scans, stress echocardiograms and nuclear cardiology typically require prior authorization. Similar to step therapy with medications (more on that later), a patient may need to jump through utilization hoops before prior authorization. For example, in order to get an MRI authorized, a patient may need an initial x-ray and physical therapy treatments first to show that lower-cost treatment options have been explored.

Medications

Step therapy is a common practice with prescription medications. Patients must try generic drugs before moving to a more expensive, brand name drug, unless contraindicated due to an allergy or another valid medical reason. 

But increasingly, as personalized medicine becomes more commonplace, so do requirements to get prior authorization. And it’s not just limited to prescriptions. Medications used in the course of treatment, such as chemotherapy delivered at an outpatient facility, can be subject to prior authorization as well. 

In addition, securing prior authorization for medications can be especially burdensome for providers with patients that have chronic conditions because the prior authorizations need to be renewed. Recognizing this, the California Department of Health Care Services (DHCS) recently announced that its Medi-Cal RX has enacted multi-year prior authorizations (up to five years) for certain maintenance medications used for chronic conditions, such as anti-hypertensives, diabetes medications, anti-depressants, asthma inhalers, or hormone agents. But that’s just one payer in one state. Prior authorization software can automate the process, whether for new medications or maintenance ones, so that patients can get what they need, sooner. 

Physical and occupational therapy (PT/OT)

PT and OT services typically require prior authorization. Automating the process can help expedite care for patients who need it. This is especially useful because physical therapy prior authorizations typically cover a set number of visits, after which, the provider must again seek authorization to continue the treatment.  Take a closer look at how prior authorization software benefits physical therapy providers. 

Durable medical equipment (DME)

Durable medical equipment is yet another service line that benefits from use of prior authorization software. DME includes everything from apnea monitors and oxygen concentrators to prostheses and mobility aids like wheelchairs. The need for DME climbs with an aging population, so the volume of prior authorizations needed will climb as the 73 million Baby Boomers in the U.S. enter their retirement years. Prior authorization software can shorten the turn-around time for requests, ensuring patients can have the equipment needed to make aging in place more possible. 

Outpatient surgeries

Payers direct members toward ambulatory surgical centers (ASCs) as a more economical option to hospital in-patient surgeries. However, that alone does not eliminate the need for prior authorization. ASCs already operate with tighter margins. Embedding efficiency in the prior authorization process allows ASCs to keep expenses down without sacrificing care quality. 

Implementing automated prior authorization in these service lines can lead to measurable benefits. Reducing wait times and increasing efficiency delivers a better experience for both patients and providers.  What are you waiting for? 

Connect with us to learn more about Myndshft prior authorization software.