Neurology Prior Authorization
Find Out How Outsourced Neurology Prior Authorization Can Streamline Admin Services
Like the majority of other medical fields, neurology has to deal with a huge prior authorization burden when it comes to a variety of patient diagnostics and treatments.
Unfortunately, this burden on administrative staff, physicians, and nurses continues to grow, adding more strain and burnout to an already stressful work environment.
For the majority of neurology clinics and departments, prior authorization has negative impacts on patient access to timely appointments.
However, the impact can have much more significant results for patient care.
At DataMatrix, we have expertise and experience in handling prior authorization, which has provided us with direct insights into how beneficial the approach is.
Let me show you how this experience has helped our clients.
How Does Prior Authorization Impact Neurology Departments?
Most patients who require the services of a neurologist will encounter a wide range of imaging, scanning, diagnostic, medication, and surgery treatments that require prior authorization (PA) first.
Because so much of what neurologists do falls into the prior authorization category, there is hardly anything that doesn’t end up with several days to more than a week of delays.
And there are two ways in which the prior authorization process causes inefficiencies and a worse experience for patients.
First of all, admin teams and neurologists have to spend many hours each week submitting requests on different systems and with different data requirements.
This often leads to missing or incorrect information, which means the insurance companies reject the request and ask for a follow-up PA process to gather more information.
Ultimately, this leads to delays that take days to resolve and many hours of researching the required data and waiting on hold while calling an insurance company.
What Types Of Neurology Services Require Prior Authorization?
Because of the highly specialized area of neurology and the fact that treatments are generally very complex and expensive, there is an increased need for prior authorization in this field.
Here are just a few of the things that neurology practices and health care providers need to request prior authorization for:
- CT scans
- MRI scans
- Long-term pain management
- Pain relief injections
- Spinal surgery
- Neurological disease treatments
Because of the complexity of the medications and physical treatments involved in patient care, there is typically a lot more information required from medical records and prior assessments and diagnostic processes.
Ultimately, it makes the overall PA process much more time-consuming and prone to errors and omissions that cause further delays and administrative overhead.
Challenges For Neurology Practices
Through many years of working with neurology departments and clinics, we have identified four key areas where the prior authorization process has the biggest impact.
We have also analyzed research from the American Medical Association on how prior authorization impacts health care providers.
Researchers at the American Medical Association conducted in-depth surveys at a variety of different medical departments to assess what the true burden of prior authorization is.
They found that even with modern electronic prior authorization systems, every doctor and their support teams spend over 16 hours a week handling prior authorization requests. For a practice that has multiple providers they will need to assign a team of staff to exclusively handle prior authorizations.
However, in our experience at DataMatrix, we have seen the amount of time is much higher in neurology because so many more treatments and diagnostics fall into the PA category.
The first major impact of this is that doctors, nurses, and administrative staff will have to deal with prior authorization forms more frequently and collect extensive data from medical records to try and achieve approval on the first request.
However, due to the complexity of the forms and extensive information being required, it regularly happens that insurance companies request more information and corrections.
These requests then lead to further delays, and physicians and admin teams have to gather the missing information and often spend hours waiting on hold to resolve problems.
Unfortunately, this process is not getting less complex or easier to administer in all health care fields, which means that delays and admin overhead are constantly growing.
In busy neurology practices, it’s very common for doctors to have long waiting lists and short consultation time slots. With so much time tied up in having to deal with prior authorization, there simply is no other way to get the work done, even in a long work week.
It’s an unfortunate reality that has impacts on patient care and satisfaction.
Patients have to wait a lot longer to get their appointments with neurologists, and during those consultations, they often feel like they are being rushed, which doesn’t create peace of mind and trust in the services.
From a physician’s perspective, it also means they have less time to go into more detail about symptoms and treatment progress, when they have the constant distraction of urgent admin tasks.
Even with advanced electronic prior authorization systems, it can take 3–5 days to receive the first response from an insurer.
The American Medical Association confirmed this time frame through surveys with doctors, where 33% of physicians said they had to wait up to five business days.
What’s important to add here is that this is just the time it takes to receive the first response. In many cases, that response will include requests for more information or outright denials.
As a result, physicians and admin teams have to invest more time and effort to research and follow up with insurers, meaning that the total time for approval can take more than a week.
For patients, that is a very long time, which causes stress and anxiety. It’s also a situation that leads to longer treatment times and worse outcomes than if treatment had started much earlier.
Benefits Of Outsourcing Prior Authorization
Here at Data Matrix, we have worked with many neurology departments and clinics in America, and we have extensive experience in making this process as efficient as possible.
From this experience with many clients, we have found three main areas where benefits are most impactful.
While electronic prior authorization systems can make it easier to avoid submissions with missing information or errors, there is still no standard submission system for all insurance companies.
When you add in the fact that new medications and treatments get added to the process on a regular basis, then you quickly get into a complex maze of different forms with varying requirements.
At DataMatrix, we have heavily invested in training staff on all prior authorization systems, with regular education programs scheduled to bring them up-to-date on new and changing requirements.
As a result, we achieve consistency for approvals with the first submission to save time and effort for follow-up research.
While outsourced prior authorization will still require some input from neurologists, nurses, and admin staff, the amount of time is a fraction of the normal burden.
With research showing that every doctor and their support team spends 16 or more hours on prior authorization requests, imagine how much more efficient admin teams will be without this burden.
Eliminating that many hours is difficult to achieve in health care, and our experience with clients has shown that this leads to far more effective running of neurology practices.
The other feedback we regularly get from clients is that they report significant improvements in patient satisfaction. Ultimately, this is one of the most important metrics for any area of health care, and it positively reflects how effectively departments work to resolve medical problems.
With patients more confident that they are receiving the attention and treatment they need, it also reduces stress and anxiety that can have negative impacts on outcomes.
That’s why it’s our top priority at DataMatrix to make your administrative processes as efficient as possible so that you can focus on patient care rather than paperwork.
Find Out How DataMatrix Can Handle Your Prior Authorization Process
Call us today to find out more about how much time you could be saving every week with an outsourced prior authorization partner.
We have highly trained and specialized teams for all medical areas, including designated staff who deal with the special requirements involved in neurology.
You’ll also learn how easily we can adapt to changes in demand so that administrative overhead doesn’t become a bottleneck for your department’s efficiency.
With less burnout for neurologists and admin staff and significantly improved patient satisfaction, this could be one decision that makes the biggest impact on how you operate.
