Wiki authorizations in the physician office.


Fairfield, IA
Best answers
We are a busy family practice office with 9 providers. We are currently having a huge issue with the amount of time our nurses are spending doing prior authorizations for radiology procedures and drugs. Some of my providers are wanting to upcode the visits to offset the time the nurses are spending, I disagree with this unless the nurse is in the room with the patient performing the authorizations, which may not always be the case, and around here unfeasible. I have been doing some research, but really haven't come up with anything that I think will make my providers happy. What are your offices doing to combat this? Would love to hear from you.
You cannot upcode based on time spent by nurses on the phone. E&M codes are based on specific criteria as laid out in the CPT book, and the 95 and 97 guidleines. This is just part of practicing.

Is there a way to streamline the auth process? Have one dedicated employee to do them all? Are your nurses using the payer websites? Are they multi-tasking? Using the web while the wait on hold for another insurance company? Are there non-urgent ones that are allowed to be faxed in? Are they up to date with payer policies, so they are not wasting time when and auth is not required?

Also, "nurses in the room" does not make a difference either. Nurse time and most supplies is all inclusive of the professional fee reimbursement.

Good luck!
authorizations in the physicians office

In our facility the HIM Department takes care of most of the preauths for the radiology department. We have the physicians fill out a form with all the information needed and we go from there. Sometimes they have to speak to a nurse reviewer.