Hear how in-house staff are working authorizations differently these days.
What’s one payer trend you’re focusing on these days?
Kathryn Wrazidlo: "Many insurance companies are asking for more prior authorizations for procedures than they used to in the past. And so it takes longer for a team to be able to get all these prior authorizations. We need to start with making sure everything is complete with the physician's order: The physician's order needs to have the right diagnosis and CPT code and also the medical reason for the procedure. After that, we have the scheduler make sure that the scheduling is complete with coverage information verified and demographic information verified, so they can begin the process for obtaining the authorization. When the patient has to get a procedure done, it traditionally can take up to 40 days for the payer to authorize the request. Once they do finally authorize it, it still can take some time for that information to get back to us. And so, with this change (increasing frequency of requests for prior authorization), we decided that we need to go with an electronic system to keep up. Instead of our team spending 40 minutes per prior authorization going out to websites to do the verification and waiting for that information to come back, we would like to go with an electronic system that actually brings us when that authorization is ready or alerts us if there's a question within the authorization. So then in the meantime, our team could continue to do additional work while waiting for that authorization to come through.”
