How to Boost the DME Prior Authorization Process?

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DME Prior Authorization

The majority of patients are awaiting DME prior authorizations, which is putting their health at risk. As a result, you must secure previous authorizations for patient DME as soon as feasible. As a result, you’ll be reimbursed and your patients will get the care they need.

The good news is that you may reduce your prior authorization load by arranging your workflow with an emphasis on building relationships, improving accuracy, and being diligent. Here are a few ideas to help you get those DME prior authorizations approved as quickly as possible.

Preventing Cancellations of Treatment

Prior permission for a patient service is more than a formality. It’s a process that affects the patient’s health. According to the 2017 American Medical Association survey, 64% of patients waited for at least one business day for a DME prior authorization decision from their insurance plan in a week, while 30% waited at least three working days.

In addition, 92% of physicians believe the process delays access to medical care. According to 78% of respondents, these delays commonly result in treatment abandonment, and 92% believe the procedure has a negative impact on patient outcomes.

PMS and EMR systems

Your PMS/EMR systems are almost certainly costing you a lot of money. Collaborate with your PMS/EMR vendors to develop the management reports you’ll need to track and enhance the efficiency of your DME prior authorization process. It can be used to create workflows with no room for error.

Your management reports should show when authorizations are required and when they are received. Use your PMS/EMR vendor’s additional resources, including user groups and conferences.

Importance of documentation

Clinicians must be trained on the DME prior permission process for their patients. They should be aware of the patient’s insurance coverage as well as whom to contact if the operation changes in the middle. They should, however, be schooled on the entire method because their documentation is of prime important to the process.

Make sure they understand the conservative treatment, as insurance companies will often want proof that conservative treatment failed before authorizing a more invasive procedure. Inform the doctors of your problems and offer your feedback.

Overcoming your denials

Although denials are uncomfortable, they can be used as a teaching tool. You’ll be able to avoid future denials if you work through past denials. Denial reports should be included in your practice management system to assist you in determining why the denial occurred in the first place.

To figure out what happened, look for patterns in these reports. Then, with your PMS/EMR vendor’s help, develop a system that allows your software to operate for you. Create reports that emphasize the combination of payers and treatments that require DME prior authorization, so that your team is informed.

Hence to summarize, DME prior authorization is a time-consuming process. To make the process go smoothly, you’ll need all of the necessary software and professional personnel. The tips above will help you make the procedure far more effective and productive in the foreseeable future.