Why is DME Prior Authorization Such a Hot Topic in 2021?

DME Prior authorization (PA) stands in the way of physicians providing care to their patients, and the process needs to be improved. Learn why this topic caught the attention of patients, physicians, politicians, and other stakeholders in health care in 2021. 

DME Prior authorization is a cost-cutting mechanism used by health plans that require physicians to obtain approval prior to delivering the recommended treatment or required service in order to qualify for payment. The DME prior-authorization resources are here to help with:

• Reform
• Increase practice efficiency 
• Give statistics 

To demonstrate the need for change.

Here's why DME Prior authorization became such a heated topic this year

Reason1: DME Prior authorization imposes a significant burden 

According to an AMA survey of 1,000 practicing physicians, medical practices pay an estimated two business days each week. This is to comply with health plans expensive and underutilized DME Prior authorization procedures. One-third of practices have employees who spend 50% of their working hours dealing with DME Prior authorization inquiries and follow-ups.

It was also shown that nearly 90% of physicians reported that the administrative load associated with DME Prior authorization requests has increased in the last five years. Specifically with the majority claiming it has increased significantly.

A practice will complete 29.1 DME Prior authorization requests per physician each week on average. This will take 14.6 hours to handle. According to the poll, almost half of the inquiries are for medical services, while the other half is for prescriptions.

Reason2: DME Prior authorization harms patients by delaying care

The belief that DME prior authorization impedes patients' access to care was nearly universal among physicians polled by the AMA. Historically, plans used DME prior authorization to cover newer or more expensive services and medications. Physicians, on the other hand, report an increase in the volume of DME prior authorization in recent years, including requirements for drugs and services that are neither innovative nor expensive.

Reason3: States can take action to correct DME prior authorization gone awry

States are using a model reform bill produced by the AMA Advocacy Resource Center to take meaningful efforts to reduce unnecessary obstacles from the DME prior authorization process. Patients are also getting active by informing their legislators about how PA has hampered their access to needed care. 

Reason4: DME prior authorization’s time-consuming nature

Certain healthcare clinics in the USA, for example, showed how it spends millions on DME prior authorization processing. This includes sending multiple faxes hundreds of times per month because the first was not acted on, and thousands of times per month the health system must make the five-plus calls required to move a DME prior authorization request ahead.  

Key takeaways

Take the call and plan your strategy for making the DME prior authorization procedure more convenient for your clients. In-house management fails to comprehend their clients' needs, and outsourcing employees execute in a different manner. DME Prior authorization approval is the most important component for starting and finishing the process. 

Follow-up is the best method to avoid delays in DME prior authorization, and payer side experience always gives an advantage. Personnel provide a well-planned, concise, and well-articulated submission with accompanying clinical data. These three components, it was shown, significantly lowered the chance of dismissing prior authorization appeals.