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Optimizing prior authorization documentation

Answers in Practice

By Swapna Bhatia, MPH, December 1, 2020

Each month DermWorld tackles issues “in practice” for dermatologists. This month Swapna Bhatia, MPH, the Academy’s health technology and informatics manager, explains prior authorization optimization.

Do you know everything that prior authorizations entail? Have prior authorization requirements increased anxiety among you and your practice staff? Are you fed up with the long process involved in prior authorizations? You are not alone.

According to the 2020 AAD Prior Authorization Survey, assigned staff spend up to 3.5 hours each day doing prior authorizations. Additionally, of the 25% of patients who are put into the prior authorization process each day, only half are successful in the process. Moreover, administrators believe they could schedule five additional patients per day in exchange for the time spent on prior authorizations.

The Academy knows that prior authorization requirements are one of the top administrative burdens for dermatologists. In order to ease this process, the Academy has come up with different strategies that will optimize the prior authorization experience and make it less burdensome for physicians and their staff. The following tactics can assist you in managing prior authorizations in your dermatology practice.

1. Delegate. Don’t do this alone. Delegate the task to one of your trusted staff members, such as a non-physician clinician and/or medical assistant. This way you will have more time with your patients and more time on your clinical notes. This also includes any task you believe is necessary for the patient to follow through on their end.

Prior authorization and drug pricing

Get more information on prior authorization and drug pricing.

2. Communicate. Since several parties are involved (dermatologist, patient, health insurance company, pharmacy, and more), it is very easy for communication to fall through the cracks. Make sure your staff member is keeping tabs on what the prior authorization status is and is following up with you and the patient.

Also, remind the patient that if they receive any updated information from the pharmacy or health insurance company, they should let your practice know right away. There are many times that the health insurance company forgets to update the practice, so the easiest way to do this is by letting patients know they can use the secure messaging system in your practice’s patient portal. Learn more about patient portals on the Academy’s EHR optimization page.

3. Use automated prior authorization tools. There are several prior authorization health programs out there, such as CoverMyMeds, SureScripts, and PriorAuthNow.* These tools have shown that dermatologists can improve efficiency, simplify tasks, and reduce overall time spent on prior authorizations.

*The Academy is able to share these options on an informational basis only. It does not represent an endorsement by the Academy. Please compare, evaluate, and consider which ones best meet your needs.

4. Price it out. Do your patients tell you they cannot afford their medication? Cost is one of the biggest barriers to patients being able to obtain their medication, especially when patients lack insurance or when insurance does not cover costs. High cost can push patients to abandon treatment.

Fortunately, the Academy has a drug pricing tool through RxSaver that provides pricing information.*

There are also other programs available to patients to help provide prescription drug assistance:

NeedyMeds: National non-profit organization that provides free information on programs for people who cannot afford medications and other health care. There is data on more than 5,000 assistance programs, 13,000 free/low-cost/sliding scale clinics, and 1,500 drug discount coupons.

RxAssist: Offers a comprehensive database of patient assistance programs run by pharmaceutical companies that provide free medications to people who cannot afford their medicine.

The Medicine Assistance Tool: Helps qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them.

*RxSaver and AAD/A shall under no circumstances be liable (regardless of the basis for the action) for any damage, side effects, or other injury suffered by any person due to any pharmaceutical or any other product dispensed in connection with member’s use of the Licensed Product. Savings calculated based on the pharmacy’s cash price. See RxSaver.com for details.

Prior authorization information

Get more information on prior authorization.

5. Appeal. Have any of your patient prior authorizations been denied? If so, use the Academy’s prior authorization appeal letter generator. It is an easily downloadable, customizable tool for select dermatologic drugs and diseases. As of August 2020, 53 drugs are included in the tool.

6. Call the insurance company. Are you clear on what documentation is required for different health plans? If not, call the insurance company to obtain a list of their requirements and make sure you document this call for future use. Create a point of contact at the insurance company you can maintain a close relationship with should you have future questions.

7. Set expectations. Prior authorizations take time, and this should be communicated with all your practice staff and patients. This way, you set expectations on all ends and are ready for whatever is to come.

To learn more on how to optimize your prior authorization process, check out the new prior authorization resources.