Prior Authorization: A Doc Insider Tells How to Prevent Denials

Robert Neaderthal, MD, MBA


August 06, 2019

8. Keep Up-to-Date on Health Plan Changes

Monitor your insurance plans for updates to the prior authorization programs. Your PAL or other staff member should keep track of health plan provider newsletters, bulletins, and websites for any updates. Health plans frequently change their prior authorization programs.

Once a year, RBMs update their guidelines and post a new copy on their website. It is critical for you to delete the outdated guidelines and paste the new version to your desktop.

The Importance of Staying Current

In addition to the four advanced imaging modalities, prior authorization is now required for a growing list of other medical services, which RBMs also typically oversee.

For example, prior authorization for sleep studies, ultrasounds, echocardiograms, and myocardial perfusion imaging are now required by some insurers. And some health plans have extended prior authorization to nonradiology services, such as pacemaker insertion, chemotherapy, radiotherapy, postacute care, and genetic testing. Beginning in 2020, even traditional Medicare patients will require prior authorization for scans. So keeping up to date on changes is more important than ever.

Editor's Note: This article features additional reporting by Leigh Page.


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