Durable medical equipment prior authorization is a process through which a request for provisional affirmation of coverage is submitted for review of durable medical equipment and is furnished to a beneficiary before a claim is submitted for payment. Accurate preauthorization helps ensure applicable coverage, payment, and coding rules are met before the supplies are delivered.
Long a problem with healthcare providers' day-to-day operations, prior authorizations (PA) have seemed impervious to legislative intervention. Due to the emergence of value-based care, the prior authorization process has become more challenging for providers. The DME PA is an intricate process demanding meticulous documentation, a comprehensive understanding of payer requirements, and effective communication with the payers. Delays and denials are potentially hampering the patient care and revenue generation of the providers across the country.
The Conundrum of DME Prior Authorization
When patients undergo a medical procedure, they might embark on a perplexing roadblock of prior authorization. This administrative hurdle can delay the care process and leave your patients frustrated and exhausted. Furthermore, the inefficiencies within the process can invite revenue generation disruptions and hamper the quality of care.
The preauthorization process is tedious due to paperwork, numerous phone calls, and countless fax transmissions. This reduces the valuable time of care and contributes to staff burnout. The unpredictable nature of DME prior authorization is a major challenge for providers and patients.
As per a survey by the American Medical Association, physicians and their staff spend almost 14 hours a week per PA. That is nearly two-business days which can reduce the time of quality care and increase patient dissatisfaction.
A report suggests that more than 60% of the providers use a manual system for DME PA.
This increases error occurrence thus hampers the revenue generation and care process. The CAHQ index report of 2023 has shown that only 31% digitization of the preauthorization process, which means the vast majority is using phone calls, faxes, and other outdated technology to transmit their requests to payers. This potentially adds hours that would be better deployed towards higher value functions like patient care.
Best Practices in DME Prior Authorization
1. Monitor payer newsletters and stay updated with the guidelines of PA requirements. However, the insurance payers are notorious for releasing information haphazardly, and
changes within the same can potentially harm patient care.
2. Establish protocols or templates for accurate information collection. Your staff should be careful while collecting data and processing the same in DME prior authorization process.
3. Follow up regularly to proactively address the issues that may arise. DME preauthorization can be held up for many reasons. Therefore, you will need a dedicated staff to handle your PA process.
4. To handle the PA denials, you need a concise and deliberate appeal process that will ensure the accuracy of the documents and consistent follow-up to eliminate the issues.
Partner with an Expert
By adhering to proper guidelines and industry-comprehensive practices, prior authorization experts at Sunknowledge Services Inc. can improve your experience. By partnering with them, you can have an extended operational arm that can handle all your DME prior authorization challenges.
Only Sunknowledge can provide you with-
80% cost reduction almost immediately
Increase in collection rate up to 97%
99.9% accuracy within the processes
Ensured 100% PA submission on the same day
100% HIPAA compliance
To conclude, DME Prior Authorization emerges as a formidable barrier in the healthcare landscape, impeding the care delivery process. However, with a reliable revenue cycle management partner, you can eliminate the gridlocks within the PA process.