EoE Module 12 References-AMA prior-authorization-tips

AMA prior-authorization-tips_0

Pdf Summary

The document provides guidance for physicians on reducing the burden of prior authorizations (PAs), which are time-consuming processes that can delay patient care. The American Medical Association (AMA) advocates for minimizing services requiring PAs and promoting automated PA processes. As health plans will likely continue using PAs, the AMA offers tips to enhance practice efficiency and manage PAs effectively.<br /><br />**Key Tips:**<br /><br />1. **Check PA Requirements Early**: Physicians should verify PA requirements before providing services or sending prescriptions. This prevents claim denials for services and ensures timely medication adherence.<br />   <br />2. **Consistent Documentation Protocol**: Establish protocols to consistently document data required for PA in patient records. This avoids delays and minimizes follow-ups.<br /><br />3. **Select Efficient PA Methods**: Choose the most efficient PA method, such as electronic transactions, payer portals, or secure emails, based on the circumstances and the health plan's options. Electronic methods can integrate into EHR workflows for faster approval processes.<br /><br />4. **Regular Follow-Up**: Track PA requests and follow up for timely approvals to prevent processing delays. Date and time-stamped documentation can help manage this process effectively.<br /><br />5. **Appeal Inappropriate Denials**: Submit well-prepared appeals with supporting clinical information when PAs are denied. The appeals process can be tedious, affecting patient care, but it's essential to pursue when medically necessary.<br /><br />The document highlights the challenges of manual PA processes and advocates for adopting automated solutions, which are not yet widespread. By following these tips and leveraging available technology, practices can reduce the administrative burdens and inefficiencies associated with PAs and improve patient care outcomes. For further resources, AMA’s website offers additional guidance on PAs and appeals.

Keywords

prior authorizations

American Medical Association

automated PA processes

practice efficiency

documentation protocol

electronic transactions

appeals process

patient care

administrative burdens

health plans