Delays in DME prior authorization will, indeed, steal your time as a physician. It will raise your practice’s expenses. It can stymie your entire care management approach and cause serious setbacks. Getting in touch with professionals in practice management who understand the payers’ claims adjudication priority should be one of the options.
While there is no straightforward road map ahead, some functional best practices will eventually assist you in staying ahead of your verification and authorization tasks. According to research, in the United States, DME prior authorization costs are currently close to $32 billion. It is critical to comply with the regulatory environment and how pre-service information will be disclosed.
DME Prior Authorization’s ideal procedure flow
Checking the standards before providing services, as well as avoiding delays in reporting prescriptions and claim denials, are required:
- Lost Payments
Payments will be lost as a result of DME prior authorization requirements and unmet criteria. A consistent capture management method is required to aid in speedy eligibility verification and reduce time in first-time DME prior authorization requests.
- Consistent Protocol
A primary problem in the DME PA process is the establishment of a standard methodology and consistent documentation. It is critical to use a consistent method to avoid delays in the patient therapeutic process.
- Develop an actionable plan
You must create an executable plan that will assist you in avoiding unnecessary follow-ups with patients for more information. DME Prior authorization requests that take as little time as possible will be a valuable asset. Comprehensive mechanisms and trained resources knowledgeable about claim adjudication mandates will be essential.
What are the necessary undertakings in DME Prior Authorization?
DME Prior authorization requires scenario planning and picking the best alternative in a certain case. We are all aware that there are numerous options available nowadays, including the ability to access standards electronically.
- There are portals with health plans. Fax, telephone, and email are some of them. The American Medical Association’s toolkit clearly discusses the potential benefits and drawbacks of each strategy.
- Making informed judgments is a crucial discipline. The strategic idea should be to choose the best alternative for your practice.
- Regular follow-up and timely pre-approval are essentially manual processes. This is why many requests get lost in one of the many steps you take.
- Track your earlier DME PA requests to avoid the delays that can occur when information is shared insecurely. Rapid automation solutions that simplify medical billing will be an important goal.
Hence to summarize, a well-articulated appeal can assist you in countering incorrect DME prior authorization and building a solid case with relevant clinical information. The re-submission of missing data from the initial request must be succinct and well-organized. Consider using technology to set a high standard in medical billing that makes sure checks and balances.