How to Obtain Health Insurance Prior Authorization in 3 Minutes or Less

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How to Obtain Health Insurance Prior Authorization in 3 Minutes or Less

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Whether you’re a doctor, nurse, or office administrator, it’s likely you have dealt with the time-consuming hassle of obtaining a prior authorization for prescriptions and tests, such as lab tests or radiographic imaging. Obtaining health insurance prior authorization for procedures takes up an inordinate amount of time for physicians and their staff.

Recently, a doctor recorded the 21 minutes it took him on the phone for a pre-authorization for a CT–scan which was absolutely clinically indicated and should not have required nearly half an hour of the doctor’s time. Physicians often find themselves completing tasks that are required to provide care to patients, but are not reimbursable, and this just increases the workload on top of their already full schedules.

During a recent encounter, I needed to obtain prior authorization for a brain MRI for a young girl with severe headaches. Because of the difficulties and extremely time-consuming process of obtaining prior authorization, I was able to utilize a new tool, MyConsult, available from the Medical Algorithms Company.  The MyConsult tool allows a healthcare provider to answer questions based on a peer-reviewed evidence-based study to determine whether or not the patient’s clinical status is in need of further testing/imaging.

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For my patient, I used the algorithm, Alarm Signs and Symptoms in Headache Indicating Possible Serious Intracranial or Systemic Pathology, and in under three minutes, I was able to answer the questions, create a PDF document to which I could add patient information along with the answers to the algorithm, and include the evidence-based study reference, to send along with the clinical notes to the insurance company.

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An approval and prior authorization was granted nearly immediately, thus eliminating the 30 to 60 minute phone call and delay in caring for other patients during that day.

Saving time during a busy day in the clinic, obtaining prior authorizations on the first try, and improving healthcare for patients are prime examples of how this new tool, MyConsult, can assist busy offices and healthcare practices in updating prior authorization for laboratory testing, medical imaging and more.

Some additional ways the MyConsult tool can save time and resources for physicians include:

  1. Documentation of your evaluation. You may want to refer to it at a later time. You may want to retain it for safekeeping or professional due diligence.
  2. Sharing results of an evaluation with other physicians, hospital staff, colleagues, or with administration and billing departments. You can easily share patient condition summaries between shift changes, during hand-offs, physician sign-outs or between nurses at shift changes.
  3. Reimbursement is a primary benefit of the Consult Report. You can include evidence-based documentation with claims for quicker coverage/reimbursements from payers. In many cases, the Consult Report substantiate your claim, and significantly reduce the likelihood of payers not approving your reimbursement request. The Consult Report speeds up insurance company approvals for home health care before discharging a patient from the hospital.
  4. Telemedicine and primary care professionals have to diagnose a wide range of possible conditions. The evidence-based analytics help to substantiate whether a particular disease is present or not. The Consult Report is a professional documentation of the diagnosis and serves as an effective decision support tool and second opinion for the telehealth professional. You can support your diagnosis with evidence-based analytics and send off the Consult Report quickly, thereby reducing staff work and phone time.

With evidence-based algorithms in every medical specialty available online and via iOS and Android app, doctors are now able to spend more time with patients and less time on the phone and inside of the EMR.


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By | 2016-12-15T10:29:14+00:00 September 28th, 2016|Clinical Practice, Consult Tool, Insurance, Patient Care, Telemedicine|0 Comments

About the Author:

Dr. Chad Rudnick, MD, FAAP is a board-certified pediatrician in Boca Raton, FL. A proponent of incorporating medical technology into his practice, Dr. Rudnick uses telemedicine and medical algorithms from The Medical Algorithms Company in his daily practice to better serve his patients and their families. An accomplished medical writer, he maintains a popular pediatric blog, All Things Pediatric, and has written for numerous online and print publications including KevinMD.com.