The prior authorization(PA)  process can be a constant cause of challenges and struggles for many independent dermatology practices to manage while keeping their costs manageable.  This process is often time-consuming and grueling for both the patient and medical staff in charge of the process.  Prior authorization also serves the purpose to make sure that the dermatology procedures, surgeries, treatments, and medications are medically necessary and follow up-to-date recommendations for the patient’s medical problems.  

Every dermatology office uses a different prior authorization process, in addition to insurance providers requiring a variety of PAs depending on the patient’s plan and needs. Changes are taking place constantly and to help alleviate some of the prior authorization burdens, the goal of this post is to focus on strategies to improve the prior authorization process within the dermatology practice.

PRIOR AUTHORIZATION PROCESS

Medical dermatology practices should begin by streamlining and automating the prior authorization process. Changes are constantly being made by the Center of Medicare and Medicaid Services (CMS) and commercial insurance providers, when there is a foundation to the process, it reduces both administrative and physician burden.  

When the prior authorization process is streamlined it carries with it four major benefits: 

1. Decrease the amount of time that it takes for the authorization process to be completed overall. The quicker turnaround time allows for efficient scheduling for patients and increases transparency for the patients making them more knowledgeable about their medical coverage.

2. Lessen the administrative burden and amount of time handling both virtual and physical paperwork required for PA. According to the American Medical Association, approximately 75% of the staff say they feel an increased burden by the PA process.

3. Increases satisfaction with your patients. As basic as this sounds, happy patients will refer to other patients. When the PA process is simplified and minimizes patients’ anxiety from both a financial and in-person standpoint, satisfaction levels increase.

4. Keeps track of rejections, approvals, or providers that need more information. The longer the process takes to be completed, the longer it takes to care for patients and an increase in unnecessary out-of-pocket expenses.  If the authorization request is denied, the dermatologist’s office must submit an appeal with additional documentation.

When the authorization is approved, the patient will receive the necessary care or medication requested, however, even with insurance approval, costs may be high, and the patient must pay out-of-pocket. Streamlining the prior authorization process is beneficial for everyone involved but partnering with a company like BrightDrive Healthcare Solution is taking the next steps for caring for both your staff and your dermatology patients. 

Payor Changes

Insurance providers make changes to the prior authorization process all the time and with minimal notice. The notices can be overlooked by your busy staff and the unknowing patients. To improve the authorization process in the dermatology practice, it is very important that medical staff and insurance companies stay up to date on payor’s changes.  Dermatologists often communicate with payors via medical codes.  It is crucial that dermatologists and the billing staff handling the process do not overlook changes in the coding system.  For example, the International Classification of Diseases-10th Revision Clinical Modification (ICD-10-CM) will have daily updated medical codes, especially during the pandemic.  As a result, the insurance company may deny the service or medication during the prior authorization process.  Reimbursements will be delayed when the updated ICD-10-CM  medical code requirements have not been met. 

Maintaining Accurate Patient Data

Investing in a smart electronic health record (EHR) plays a vital role in easing the burden of the prior authorization process.  The EHR cuts down on re-entering duplicate data, downloading forms, and eliminates the use of fax machines.  These benefits of having a smart EHR allow the prior authorization process to go more smoothly, as it can be easier to track and monitor progress.  In addition, the EHR system will allow dermatologists to send prescriptions directly to the pharmacy. The type of services offered by your dermatology practice will help to determine your future needs and BrightDrive HCS can work with you to fine-tune your practice needs, reduce margins, write-offs, and other resource gaps. 

Additional Support For Administration

There are tasks medical staff can perform to make the prior authorization process feasible. With dermatology offices working hard to make up for the financial loss suffered this past year, medical staff will face the challenges of trying to stay abreast with current prior authorizations for procedures, changing processes from different payors, and purchasing updated software for scheduling and billing purposes.  One way to help with these challenges is by providing additional support staff like a dedicated account manager that can access fluid documentation for all medical staff.  Fluid documentation provides information about money liquidations, promissory notes, and summary judgments without adding these extra duties to your medical staff. 

Stay Informed With Industry Standards

Organizations such as the American Academy of Dermatology are a great resource for dermatologists to stay in the know about important decisions being made in their field.  Even though being a member of this organization is helpful, it does not ensure that dermatologists will be able to keep up with current trends and future changes in their practice that can include insurance procedure changes in the prior authorization process. Alleviate unnecessary burnout by collaborating with an organization like BrightDrive to keep track of all the changes needed to keep your practice financially afloat. 

During the prior authorization process, there is no guarantee the authorization for the requested dermatologic treatment or medication will be approved.  The process can be frustrating and overwhelming especially with the evolving changes and knowing dermatologists have no control over potential outcomes. No provider wants their patient to suffer as a result of errors and rejections of medication or service needed for their healing. Start by determining what aspects of the prior authorization process needs updating, and work to develop a roadmap that not only benefits your practice but your medical staff and patients. 

Does your staff spend too much time on the prior authorization process without obtaining the necessary results? Work with BrightDrive HCS to improve and streamline your workflow process and unburden your staff so they can spend more time with patients. Contact us to learn more about how we can help your dermatology practice today.