In a 2018 survey of 700 radiation oncologists conducted by the American Society for Radiation Oncologists (ASTRO), 93% of oncologists reported potential life-saving treatments get significantly delayed for patients due to prior authorization hassles.
Patients and providers alike are justifiably anxious about these delays. Oncologists and most in healthcare recognize that when a patient has a cancer diagnosis, cutting time to therapy initiation can make a life or death difference. Research from the renowned Cleveland Clinic links each week of delay in starting cancer therapy with a 1.2% to 3.2% increased risk of mortality.
It’s alarming to note that 31% of the ASTRO study respondents say the average delay is five days or longer, a period that amounts to one full week of standard radiation treatment. Clearly, getting oncology treatments started quickly improves survival rates and outcomes.
Providers can take proactive steps to speed up prior authorization so that patients get the care they need within one to two days. The following steps for prior authorization acceleration not only support patient care, they create deep patient appreciation for the practice.
Submit a powerful prior authorization
First, the fastest way to reach the payer and get the prior authorization into the queue is to submit online. An online submission gets you an instant notification or email to let you know when and if you’ve been approved.
Another tip: if you must submit by fax, once you get a confirmation that your fax has been sent, do not send another fax. Only send your fax once. Duplicate information causes delays.
Submit thorough patient information with precision
Correct and consistent patient, procedure, and test documentation help ensure no needless errors interfere with prior authorization approval. Don’t overlook patient demographics, dates of service, and procedures.
Make sure to take the time to associate diagnoses, procedures, treatments, and tests accurately as well. One of the most common reasons prior authorizations are denied is payer confusion over which tests are needed to confirm which diagnosis, particularly when several tests and several diagnoses are involved. There may even be several tests specific to one diagnosis. Providers that fail to associate diagnoses with tests get prior authorizations denied.
Another element supporting a smooth prior authorization comes when providers clearly tie thorough documentation to the relevant test or procedure. When documentation is high quality and provides sufficient detail as to why procedures and tests will effectively treat the specific cancer, swift prior authorizations follow.
Submit extensive information from the patient’s medical records
Another way providers can speed prior authorizations in complex oncology cases is by submitting extensive patient medical record information. Most providers know to include clinical indicators and physical documentation, but many neglect to include lab and radiology results, past notes, previous surgical notes, operation notes, and office visit notes. Including extensive medical records results in a higher likelihood of approved authorizations, and it speeds the payer’s response time.
Conduct careful research into state laws
State laws can be an ally to providers and patients looking to get a quick prior authorization for oncology treatments. Every state mandates prior authorization response times.
For instance, in Alabama, the prior authorization response time is 2 business days. For Kansas, payers have 24 hours to respond to emergencies and 72 hours for non-emergencies. The minute your prior authorization has gone beyond the state-mandated time period, you are within your rights to call the payer and say, “you are beyond mandated prior authorization response time regulations. You need to expedite.” With fines and bad press looming, rest assured that they will respond.
When it’s cancer, prior authorizations must be accelerated
Cancer treatments have made incredible progress in the past 10 years. Experts even believe that new breakthroughs will increase cancer survival rates during the next decade and beyond. One of the most powerful elements driving down cancer mortality rates is early detection and treatment. Providers save lives when they accelerate quick prior authorization turnarounds.
In a perfect world, the prior auth specialist would have unlimited, pressure-free time to tackle this Herculean task. With each prior auth taking two to three hours to complete and many in the queue, however, errors and insufficiencies can result.
One solution is to turn a portion of the prior authorization work over to AI- and machine-learning-driven software. Infinx’s Prior Authorization Solution handles complete coverage of your prior authorization requests with a 98+% accuracy and 99.5% adherence to turnaround times. Developed with our experts’ deep knowledge of individual payer requirements, the system ensures all necessary information is uploaded before submitting. You avoid auth requests getting kicked back to you due to lack of information. The most complex requests require human intervention. These go to our team of certified specialists who have navigated the issues you need resolved countless times. They are experts in addressing the complexity of cancer and specialty therapy prior authorizations.
If you could use some backup in handling the burden of complex oncology prior authorization requisitions, contact Infinx to request a demo.