DME Prior Authorization: Today and Tomorrow

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DME Prior Authorizations

DME Prior authorization of healthcare operations is crucial in payer efforts to manage costs while also ensuring patient safety and compliance. Prior approval, on the other hand, is frequently considered by providers as a necessary evil burdened with administrative difficulty.

According to an American Medical Association poll performed in 2017, 84% of survey participants evaluated the burden of prior permission on physicians and personnel as high or extremely high. According to other surveys, doctors spend an average of 20 hours per week and approximately $83,000 per year working with insurance companies.

These figures will continue to rise as the prevalence of DME prior authorization requirements rises. The best part for providers is that as the healthcare sector transitions to value-based payment models, we can anticipate a lessening in prior authorization requirements or a movement to an alternate DME prior authorization scheme

However, unless there is significant prior authorization change in the healthcare business, providers must continue to obey the rules set by payers. Here are few steps that provider organizations can take right now to simplify the prior approval process.

Understand what is required

Check the authorization requirements before providing care, especially for procedural and surgical services. Examine and use available payer coverage determination criteria and/or medical policy standards to effectively provide required information on the first try.

Make your processes more efficient

Concentrate your initial efforts on the top 10 to 15 payers. Create informational summaries for each, especially those that are easily available to staff. Track your prior permission filings and associated results with a simple spreadsheet.

Play it wisely

DME Prior authorization requests and supporting paperwork must be submitted in the proper format. Please only submit what is required. All contributions are time and date stamped. Establish formal policies, timetables, and procedures for follow-up. Create and keep standard letters of appeal on hand for use in the case of a denial.

Examine and evaluate

Arrange DME Prior authorization tracking data, split by payer, to better determine what types of care are at the risk of refusal. Determine any disparities in staff approval rates. Implement operational adjustments that focus on best practices for successful submissions.

Educate and communicate

Facilitate regular meetings with employees and providers to initiate a discussion about DME prior authorization. Evaluate main and alternative care plans in advance to account for any delays caused by services with clear DME prior authorization requirements. Keep payer profiles up to date on a frequent basis to ensure long-term success.

Important Key points

By following these best practices, healthcare institutions can improve the pace of the DME prior authorization process while reducing the strain on clinicians and staff. These measures help lower the risk of patient care delays, operational stumbling blocks, and denials.