DME Prior authorizations, also referred as prior approvals, are cost-cutting procedures used by payers to ensure that their members only receive medically essential care. Before offering specified services or commodities to a patient, providers must obtain advance approval from payers under the cost-control system.
DME Payers are increasingly using prior authorizations to save money and improve treatment quality for their members. Obtaining prior clearance for services, on the other hand, places a significant load on providers. According to a recent Medical Group Management Association (MGMA) poll, 86% of providers said that DME prior authorization requirements had grown in the previous year. According to a new MGMA study, the pre-approval process was the most significant regulatory hurdle for 82% of providers in 2018.
Electronic DME Prior Authorization
Using automated or electronic DME prior authorization can help to streamline the process and eliminate errors. DME Prior authorizations that are entirely electronic can also save providers time and money.
Manual DME prior authorizations cost providers $5.75 per and take between 14 and 20 minutes of staff work, according to the 2017 cash index. Electronic transactions, on the other hand, can save providers up to $245 million and seven to nine minutes every transaction.
Check for the Client Requirements
DME Prior authorizations, according to the vast majority of physicians, impede patient access to care. DME PA from payers is typically required before doctors may begin a treatment plan. Payers may, in fact, refuse to process payments or prescriptions, forcing providers to waste time completing additional documentation or submitting an appeal.
Providers may be unable to influence payer decisions on DME prior authorizations or the time it takes insurance to make a decision on a case. They can, however, establish a proactive plan to avoid service disruptions. The AMA recommends that you check the criteria for DME PA before providing services or sending prescriptions to a pharmacy.
Specialized Staff Integrated with the Workflow
Physicians and other providers of care are particularly irritated by the administrative hurdles associated with prior authorizations. Prior clearances for services and prescriptions, according to providers, are a regulatory burden that delays patient access to care and creates unneeded work. Transferring responsibility for previous authorizations to a specialized staff could help to reduce the stress on care delivery providers while uplifting productivity.
Key takeaways
For DME providers and their staff, prior authorizations are a time-consuming administrative burden. DME prior authorization technology lags and insurers are just shoring up their prior authorization processes to save money.
As the sector refines its usage of the cost-cutting technique, providers should be assessing needs on a regular basis, allocating prior authorizations to a staff member, and utilizing technology to avoid major set backs.
