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You are here: Home / Articles / Pearls for Preauthorization: Part Two

Pearls for Preauthorization: Part Two

October 1, 2009 • By Staff

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Last month’s “Rheumatology Practice Pearls” focused on the denial or return of preauthorization requests because of missing data. This month’s pearls focuses on obtaining authorization for off-label drugs and updating a previous preauthorization.

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Rheumatology practices are finding it difficult to handle preauthorizations. It is becoming very time consuming and frustrating to obtain authorization for off-label drugs, or even to update a preauthorization. Below are some tips from the ACR’s practice management and coding specialists:

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Off-label Drugs Pearls

  1. Verify that there is Food and Drug Administration approval on file.
  2. Confirm that the drug is medically necessary to treat the condition.
  3. Have at least two peer-reviewed articles from medical journals that present data to support the use.
  4. Don’t forget that patients are great advocates. If needed, it can strike a chord with a payer when the beneficiary calls for benefit.

Annual Preauthorizations Pearls

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  1. Compile and sort patient charts that need reauthorization by date.
  2. Maximize time by organizing patient’s charts by carrier to cut down on making multiple calls to the same payer.
  3. Make sure that patient charts include prior treatments and results.

When working to obtain preauthorizations, remember that each case will be different. It is good to have a staff person who will stay on top of insurers, particularly when it comes to working through to the final resolution. This will help with:

  1. Making personal contact at the insurance company;
  2. Decreasing hold time; and
  3. Promoting familiarity with the patient case and information needed.

Filed Under: From the College, Practice Management Tagged With: Billing, Health Insurance, off-label drugs, Practice Pearls, preauthorization, ReimbursementIssue: October 2009

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