In the February issue of Primary Care Optometry News, an optometrist who utilizes PARx in his practice was interviewed about his experience with the prior authorization (PA) process – and what best practices he would recommend. “Prior authorizations are here to stay,” Jeffrey S. Williams Jr., OD, Dipl ABO, noted in the article. “Optometrists must learn how to navigate prior authorizations in order for their patients to receive the branded medications they are prescribed.”
Williams, who practices on Long Island, New York, recommends use of a full-service PA process provider to any medical practice struggling with the challenge of PA. His office uses PARx Solutions.
Before adopting the service, navigating PA in his office was messy, Williams said. “It was a lot of blank forms from the 10 different, respective insurance companies that we accept. You’d have to fill it out, fax it and pray that it was approved. If it wasn’t approved, you’d get a 15-page fax back,” he said.
His staff would manage lengthy spreadsheets to keep track of patients, various dates and follow-up milestones. “It was a lot of wasted time and frustration,” Williams said.
Williams outlined how practice owners can assess the impact of the PA process on their practice and weigh the systems available that are intended to help. He wrote that a good starting point is looking at the individual PA process challenges at the practice. These may include:
- How often are prescriptions denied coverage because a PA is required?
- Are your patients’ managed care plans frequently changing the criteria for approving coverage for your prescribed medications?
- How important is it for your patients to receive the specific medication that you originally prescribed?
Next, he suggested appraising the current burden on the optometrist and staff in managing PAs:
- How many hours are spent on PAs including: hunting down the correct form, completing and submitting the forms and spending time on the phone with managed care plans?
- How often are submitted PAs denied by the plan?
- If denied, how often does your practice appeal the decision with the plan?
Finally, he suggested considering the PA process options: using a form-based service, or ideally, a full-service provider, per his experience with PARx.
Providers also have the option of going it alone, which Williams says may require a member of the staff focusing solely on PAs or carving out time from multiple staff members. After using the service, not only are approvals accomplished faster at his office, but through the experience, his staff has learned many of the protocols for the different insurance requirements.
“It went from chaos and confusion and shooting in the dark to seeing more patients daily,” Williams said of his practice’s transition to full-service PA provider PARx Solutions.
The above is excerpted from an article appearing on Healio.com. To read the complete article, please go to: https://www.healio.com/optometry/therapeutics/news/print/primary-care-optometry-news/%7B62e366db-cf6b-4049-807d-502eec4b17ad%7D/clinicians-provide-best-practices-for-helping-patients-access-medications?page=1