Oncology prior authorization (PA) has long been known to cause delays in life-saving treatments. Starting from the paperwork to following up with payers, all these kinds of administrative duties take up significant time. The patients and providers both feel justifiably anxious due to the same. This is where expert oncology billing services teams earn their keep.
On another note, despite the groundbreaking discoveries in cancer care, these kinds of delays can still hinder patient care. 31% of participants in a study by ASTRO has pointed out that they faced around 5 days or longer delays while trying to retrieve prior authorization from payers.
Further industry research has even concluded that such significant delays in starting cancer care can increase the risk of treatment failure and even risk of mortality. This is why ensuring timely prior authorization management is absolutely necessary for oncologists.
An expert oncology billing services team understands that. They have a thorough understanding of payer timelines and prior authorization related rules. They also bring in the necessary resources and skillset in the house necessary to tackle the same.
How Expert Oncology Billing Services Make a Difference
Starting from identifying which services require prior authorization to following up with payers, an expert vendor manages the entire PA cycle thoroughly.
Accurate form submission
One of the most significant reasons behind prior authorization failures is inaccurate prior authorization form submission. A top oncology billing company understands that and creates effective strategies accordingly. One of the first things they consider is ensuring that all information in the form is correct. For instance, they make sure details on patient demographics, provider information, and even the insurance related info are gathered on time and accurately noted on the form.
They also make sure to mention all clinical codes and specifics correctly. For instance, all prescribed clinical procedures will be coded using CPT coding system, and the products will be coded using relevant HCPCS level II codes. Additionally submitting the details on procedures and products to be used accurately is crucial. For instance, precisely mentioning the medication dosage and unit details is necessary.
Next comes identifying the correct submission method as they tend to vary from payer to payer. For instance, some payers require Electronic Prior Authorization through platforms like CoverMyMeds or integrated electronic health record tools. On the other hand, some payers require the form to be submitted via their own portals. Lastly some payers even accept form submission via offline methods like fax or mail. An expert oncology billing services team understands these varying requirements thoroughly.
Precise clinical documentation submission and follow-up with payers
The next crucial factor here is submitting all necessary clinical documentation correctly. Starting from the patient's treatment history to new lab results every detail needs to be spotless to ensure faster prior authorization approval. Expert oncology billing services providers understand that and apply significant measures to ensure the same.
First, they gather all required documentation that supports the prior authorization request. Starting from office visit notes to lab results, every relevant documentation is submitted. Submitting extensive documentation help increase the likelihood of first-pass prior authorization approvals.
Next, they will scrub them using AI-powered technologies to make sure no errors are there. If any discrepancy is found in any of the clinical documentation, they quickly connect with payers to make sure that such gaps are filled before the request form reaches the payer.
After the request form reaches the payer, the next important step is to follow up. Expert oncology prior authorization teams apply aggressive follow-up strategies. They stay connected with payers via digital mediums and even on call to make sure the request gets processed in a timely manner. Another benefit of having a constant communication pathway is that if there is any additional requirement from the payers' end, expert vendors can promptly cater to the same. This will again lead to faster prior authorization processing.
Thorough research into state laws
Another significant yet most underrated way an expert oncology billing services partner help with prior authorization management is through deep research into state laws. State-specific legislative frameworks often turn out to be groundbreaking in this arena. Fo instance, in states like Alabama, payers must respond to be prior authorization request in 2 business days. On the other hand, for states like Kansas, payers generally have 24 hours to respond to any emergency cases, and 72 hours to respond to non-emergency requests.
If the payers exceed these state-specific timelines, then the team can expedite the matter through intense follow-up strategies.
How to Choose the Right Oncology Billing Partner
Outsourcing expert billing vendors have gained significant traction in recent times amidst oncologists. The reason is the several benefits that outsourced teams offer which outweigh the offerings made by an internal team. For instance, outsourced oncology billing services are much more cost-effective options for the kind of expertise and skillset they carry in comparison to internal teams. Secondly, they help practices take care of these administrative duties, further allowing them to focus on what is more important that is offering clinical care to patients.
However, practices must realize that not all vendors are worth their time. This is why careful inspection of potential vendors before making a decision is necessary. Below are some of the most crucial questions practices must ask before hiring an expert team:
- Do you have experience managing oncology prior authorizations? If yes, how many?
- What sort of technological resources do you implement to ensure prior authorization management?
- What are your charges for managing prior authorizations?
- How does the company keep the team educated on changing prior authorization rules?
- Can you share some client references or testimonials?
- What is the onboarding process like?
Bottom Line
Cancer care has been progressing significantly over the past few years, with groundbreaking breakthroughs increasing survival rates of patients significantly. However, if delays or rejections of prior authorizations get in the way, it can defeat the entire point. This is why relying on experts is necessary. A seasoned oncology billing services partner makes sure prior authorizations are retrieved on time through accuracy and persistence. This reduces chances of any delays in patient care.
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