Radiology Prior Authorization Services


CoSource Radiology Prior Authorizations That Will Transform Administrative Efficiency

One huge administrative burden for radiology departments and staff is the amount of time and effort spent on handling prior authorization requests.

The unfortunate reality is that this is not an efficient process, and the smallest mistakes or omissions in the data provided can lead to significant delays.

Ultimately, this has a severe impact on operational efficiency and patient care, with radiologists, radiographers, and nurses often tied up in securing authorization rather than directly helping patients.

That’s precisely why DataMatrix offers an outsourced radiology prior authorization service that improves turnaround times for a far more efficient department.

How Does Prior Authorization Impact Medical Clinic Processes?

The majority of patients coming to a radiology department will require prior authorization requests for scans and imaging procedures. The process for submitting these requests involves data input by admin staff and physicians based on patient records.

Unfortunately, the process and specific details required by different insurance companies vary a lot. Processes and forms also often change to comply with regulations and changes in the healthcare industry.

The end result is that even the smallest omission in prior authorizations for diagnostic imaging procedures can lead to significant delays.

Administrative teams also face increasing workloads to make follow-up phone calls and submissions, which adds strain to teams that are often under a lot of pressure.

Staying on top of prior authorization processes and requirements also demands regular training for admin staff to ensure errors are kept to a minimum.

More on these issues shortly.


What Types Of Radiology Services Require Prior Authorization?

For radiology departments, there are many different types of scans and imaging procedures performed that require radiology prior authorizations from insurance providers.

Here are the most common ones:

  • CT scans
  • PET scans
  • Bone Mineral Density exams
  • Nuclear Cardiology
  • Stress echocardiograms

Ultrasound and diagnostic X-rays are, in most cases, exempt from prior authorization. However, there can be clinical guidelines and requirements from insurers when it comes to repeat or multiple X-rays and ultrasound scans for a single treatment.

This can often complicate things more as admin staff need to understand which imaging procedures need to go through prior authorization processes.


Challenges For Radiology Departments

Let me now draw your attention to the biggest challenges when it comes to radiology prior authorizations.

According to research and surveys by the American Medical Association, admin staff and doctors in a typical medical department or clinic spend over 25 to 40 hours on admin tasks purely related to prior authorization requests.

It’s arguably even more time-consuming in radiology departments because the vast majority of imaging procedures performed require prior authorization.

All those hours add up to a significant percentage of time that radiographers, radiologists, nurses, and admin staff have to deal with while sitting at a screen or phone rather than with a patient.

Most radiology departments will also regularly experience problems with prior authorization requests that are due to incomplete or incorrect data provided.

This leads to further follow-up phone calls and emails, with a lot of time spent on hold trying to get hold of the right person to rectify issues.

The reason this is a common problem is that all insurance companies have different systems and procedures for submitting prior authorizations.

You also need to consider that processes often change, and when new treatments become available that require investigative medical scans, there can be additional training requirements for admin staff to comply with those requirements.

It’s a maze of requirements that is only getting more difficult to navigate adding constantly more demand for administrative support.

Because of the excessive amounts of time tied up with administrative work, radiologists and radiographers struggle to find the necessary time for patients. While there isn’t much they can do about how long scans take, the end result is significant delays in appointments.

It’s not uncommon for busy hospitals and clinics to have significant waiting lists for their radiology department, and this has a direct and indirect impact on the treatments of those patients.

With radiology prior authorizations, even the smallest omission or error in the forms can lead to follow-up requests.

And those requests often take a lot of time to resubmit forms or wait on hold while trying to get through to the right person at an insurer’s prior authorizations department.

Whether it’s delayed appointments or a rushed experience at a radiology department, it doesn’t provide a positive experience for patients.

While different medical areas and treatment types have varying response times to prior authorization requests, the overall average response is in the region of 4–5 days.

While there are fast-track options for patients in an emergency room requiring immediate critical care, the majority of patients have to wait several days before they can even get the go-ahead for their type of scan.

However, as soon as there is any delay due to issues in the submission forms for radiology prior authorizations, those 4–5 days can quickly turn into more than a week.

In many types of treatments in oncology, cardiology, and internal medicine, those kinds of delays can severely impact patient care and treatment.

It also adds to stress and anxiety among patients who are left waiting even longer before they can get a diagnosis, which allows doctors to determine the right treatment plan.

Another issue that comes from delayed radiology appointments and subsequent treatments is that physicians and patients often have to resort to pain management using strong medication.

That results in two significant issues.

First of all, patients who need to wait longer than expected for their radiology appointments and treatments will have to deal with pain for longer than is necessary. That can add stress and anxiety to the experience, and it can have negative impacts on the treatment outcomes.

Secondly, in cases where patients are dealing with severe pain, doctors often have to resort to strong and potentially addictive pain medication.

This kind of treatment requires careful monitoring of the intake of those drugs to ensure that it doesn’t lead to addictions.

Overall, it can lead to poor patient satisfaction, sub-optimal treatment results, and the potential risk of becoming dependent on pain medication.

Benefits Of Outsourcing Prior Authorization

Here at DataMatrix, we specialize in providing outsourced services for radiology prior authorizations. We can speak from experience about the major benefits to physicians, clinical staff, admin staff, and, most importantly, the patients.

One of the main complaints admin staff have about prior authorization is the inconsistent layout of submission forms and the results they get.

It requires a lot of experience with each system to ensure that delays are consistently kept to a minimum.

Here at DataMatrix, we have built processes around all the insurance providers’ systems, and our team undergoes constant training to ensure they understand changes.

Because of the large volume of requests, we have gained a level of experience that ensures consistent prior authorization success without follow-up delays.

Unfortunately, there is no standardized prior authorization system across all insurance companies in America. And with dozens of providers using different systems and online forms, requesting prior authorization becomes a huge administrative burden.

Admin staff, radiographers, and radiologists need to understand how each system works, and they also need regular training to deal with changes in submission forms and processes.

It’s no surprise that most radiology departments regularly encounter requests for clarification, updates, or missing information from insurance providers.

Not only will you not have the admin overhead of handling the initial requests and follow-ups, but you’ll also reduce delays in appointments for patients with a faster turnaround time from insurers.

With so much time spent on handling prior authorization requests, admin teams are often under intense pressure to deal with all the other tasks, from managing appointments, checking in patients, dealing with billing, and updating patient notes.

Freeing up time from a highly repetitive process that often creates further follow-up tasks in radiology departments is one of the best ways to gain efficiency in other areas that you have to handle in-house.

It also frees up time with physicians and radiographers who can then spend more time seeing patients and reducing the waiting list significantly.

What all of our clients have experienced is a significant improvement in patient satisfaction. By keeping delays due to prior authorization processes to a minimum, they are able to set up appointments sooner and get more patients processed in the same amount of time.

That satisfaction level also translates into more confidence in medical clinics and reduces the amount of stress and anxiety patients need to deal with, often at the worst possible time.

Our goal at DataMatrix is to create a seamless experience for our clients and their patients and eliminate as much of the prior authorization process as possible.

Find Out How DataMatrix Can Handle Your Prior Authorization Requests

Through long-term relationships with clients in all medical fields, our team at DataMatrix has built extensive experience and expertise in the prior authorization processes.

We have dealt with all insurance companies and fully understand the importance of attention to detail when it comes to all the systems.

Our proven track record and ability to adapt to process changes and increased demand due to seasonal impacts on the number of patients give you the peace of mind that you won’t be dealing with unnecessary delays any longer.

Call us today for a free consultation, and we’ll explain how our business processes will integrate with your admin team for the most effective and efficient approach possible.

“OrthoNY’s collaboration with DataMatrix has been extremely successful. DataMatrix has been processing our prior authorizations for the past 4 years. We have experienced a significant improvement with the prior authorization requests and reimbursement.”