Innovative Techniques for Optimizing the DME Prior Authorization Process

The majority of patients are waiting for DME prior authorizations that are generating treatment delays. It is therefore vital to secure patient prior authorizations as soon as possible for you to be reimbursed and your patients to receive the care they require.

The good news is that you can start decreasing your prior authorization load by planning your workflow around creating relationships, enhancing accuracy, and being diligent. Here are some innovative ideas to help you speed the approval of DME prior authorizations.

• Select an Analyst

Given how much time your team spends on pre-certifications, putting someone inexperienced in charge of delegating the duty to a large group of individuals makes no sense. Hire someone with experience in this field instead, or put someone in charge of the procedure in your clinic.

Give them whatever tools they think they'll need to document the process and keep payer standards up to date regularly. Allow them to concentrate entirely on acquiring DME prior authorizations. Assist them in developing a project strategy to ensure that they collaborate closely on every application and denial to keep the process moving ahead.

• Proactive approach

Take charge by generating a master list of drugs and treatments requiring DME prior authorization, as broken down by the insurer. Then, before providing treatments or transferring prescriptions to pharmacists, remind all of your providers to review DME prior authorization procedures.

• File an appeal

Your DME prior authorization specialist should teach every physician in your practice how to draft a short, well-articulated medical necessity appeal. The specialist can gather enough evidence to compel a successful appeal 94% of the time. But the remaining 5% – 6% may necessitate the involvement of a health care provider. The expert can provide whatever support is needed, such as an outline to follow and vital things to include.

• Make use of technology

Embracing technology is the quickest approach to make the greatest progress on this challenging challenge. By transitioning from faxes and phone calls to digital communication, the authorization procedure can be substantially accelerated.

DME Prior authorization software is offered to minimize labor time and increase productivity when obtaining prior authorizations. On average, practices that employ precertification as their primary strategy report a 94% reduction in work volume. Even the research proposes a 50% cost reduction, which may be put to better use elsewhere. Additionally, practices with a high volume of routine DME prior authorizations can save up to five times their cost.

Hence To summarize, if you want to make the DME prior authorization procedure faster and smoother, it is best to follow the guidelines outlined above. It not only saves time but is also cost effective. DME Prior Authorizations are challenging, but they can be made easier with these advice.