Prior Authorization: What the AUA is Doing

  

Part three of this series outlines the steps that the AUA is taking to tackle the issue of prior authorizations. 

In August 2015, AUA shared its position statement on the Beers Criteria with six insurance companies. Each verified the importance of physician judgment and said the edits in place are not designed to preclude physician judgment, but rather assist in safer alternatives.

A Snap Survey was sent to the Practice Management Network assessing employee burdens and characterizing various payers. According to the results on average, a urology practice submits 80 prior authorizations. The most common services and procedures are in-patient and outpatient procedures, surgeries, high-end imaging (e.g., CT scans, MRIs), and in-office procedures (e.g., cystoscopies, biopsies, vasectomies). The most frequent medications requiring prior authorizations are prescriptions for most name-brand mediations, overactive bladder, any testosterone medications or creams, erectile dysfunction, and cancer medications. In addition, most practices indicated they have a designated staff person to conduct the prior authorization process, usually and administrative employee, billing staff person, or medical assistant. The time staff spends on authorizations ranges from 15-30 minutes per claim and 2-4 hours of total time per day. Across the board, practices indicated that the most effective way to streamline the prior authorization process was to create a universal form and requirements to which every insurance provider must adhere.        

While the AMA has advised that physicians may not charge patients for administrative time relevant to prior authorization for services as this is considered part of the patient encounter, AUA is conducting research that has revealed nine states (CO, GA, KY, VT, MD, MI, MN, ND and NM) have mandated the use of electronic prior authorization forms for future implementation, and are in the process of developing a potential uniform single page form. In addition, five states (KS, MO, NC, NH and WA) have mandated studies on the impact of prior authorizations and possible solutions.  At this time, several states have introduced legislation addressing electronic prior authorization forms.  Staff continues to monitor state policies on this topic in order to eventually provide members with resources to address this burden. Discussions have taken place on the potential creation of a toolkit to be housed on AUA’s website.

If your office has any questions pertaining to prior authorization, contact us at R&R@AUAnet.org.



#2016 #PaymentandCoverageIssues #CodingandBilling
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