The recent changes and every additions and modification to it demand a considerable amount of training for the in-house staff. The training costs skyrocket and to make it worse, handling prior authorization for DME along with other routine billing responsibilities welcome more errors. That, in turn, forces rejections and denials.

At this juncture, providers could do well with helping a guiding star. One that could bail them out of the deep waters they are sinking into. They have found out that helping hand in the professional DME prior authorization services.

Some of the prior authorization services also go beyond the usual and offers extras like standalone services, free Telemedicine platform, and other solutions like Revenue Cycle Management and Practice Management. All these services come in affordable prices that help the providers to repair the damages done without having to spend much ultimately adding to the revenue recovery process.

Challenges of Prior Authorization

⇒DME prior authorization will be never like before. What was thought to be a great reform to check the rising prices of Durable Medical Equipment and bring an overall clarity in the DME prior authorization process turned out to create complexity and uncertainty instead.

⇒Health insurance companies normally require prior authorization for medications, durable medical equipment (DME) and medical services, and insurance authorization services are available to help handle the administrative burden associated with the process.

⇒However, the American Medical Association (AMA) notes that prior authorization policies are fraught with problems like inefficiency and lack of transparency, which undermines patient care and costs physician practices time and money.

⇒Medicare through its mandate (Final Rule) issued that it is not going to pay for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) without prior authorization. It was aimed to bring transparency in the whole DME prior authorization process and it has managed to achieve its objective to a certain extent.

Here are some steps that can physicians can take to obtain preauthorization and prevent denials:

Be familiar with the coverage and preauthorization guidelines of each payer:

Surgeons must be aware of the coverage and preauthorization guidelines for payers and provide a specific diagnosis on their reports.

Follow the recommended treatment guidelines: 

Physicians should make sure they are following the recommended treatment guidelines before ordering a high-cost procedure for a patient.

Ensure preauthorization even for mundane procedures: 

Two most common procedures that insurers require preauthorization for are imaging procedures such as computerized tomography (CT) scans and magnetic resonance imaging (MRI), and brand-name pharmaceuticals.

Take steps to protect against denials: 

Providers need to have relevant information about the procedures that they routinely perform and enter into the contracting process with this information. They should have evidence to prove the medical necessity of particular procedure as well as reliable resources on coverage for certain diagnoses. Such information would also help during reimbursement negotiations.

Meet the all-payer criteria: 

Providers should make sure that they meet all of the payer’s criteria before submitting a prior authorization request.

Update contracts with insurance companies: 

Insurance companies may update their coverage policy from time to time. Providers need to track these changes and update their contracts to maintain coverage

Conduct regular audits: 

Regular preventative audits can detect issues and help identify typical denial trends for certain procedures. This will allow providers to correct minor problems that may be responsible for a large proportion of the denials. Audits should focus on diagnosis codes and final payment.

Connect at +1(302) 613-1356 or E-Mail at support@wonderws.com to discover how we can help your complex prior authorization process making it simpler and cost-effective service.