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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Explore This IssueOctober 2009
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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:
Off-label Drugs Pearls
- Verify that there is Food and Drug Administration approval on file.
- Confirm that the drug is medically necessary to treat the condition.
- Have at least two peer-reviewed articles from medical journals that present data to support the use.
- 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
- Compile and sort patient charts that need reauthorization by date.
- Maximize time by organizing patient’s charts by carrier to cut down on making multiple calls to the same payer.
- 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:
- Making personal contact at the insurance company;
- Decreasing hold time; and
- Promoting familiarity with the patient case and information needed.