Prior Authorization Can Be Messy and Cumbersome

Anyone working in a clinic knows that one of the easiest ways to derail your day is by encountering a situation that needs prior authorization. Obtaining prior authorization for surgical procedures is…a pain in the neck. At best, it is a headache needing to submit a bunch of information to insurance companies and wasting valuable time waiting for a response. At worst, it can cause surgery cancellations or continuum of care delays. The idea of adding another layer of complexity to the already cumbersome prior authorization process has led to a collective groan heard round the country.

What is changing for prior auth collection?

Insurance companies are starting to require that patient-reported outcome (PRO) surveys be completed as part of the total joint replacement prior authorization process. These surveys are generally in the form of HOOS, KOOS or WOMAC scores. These surveys are by no means a ‘quick form’ that patients can mindlessly fill out. Each survey includes on the upward of thirty (30) questions and requires thoughtful responses. After the survey questions are answered by the patient then a staff member must score the survey. While it is still being determined exactly how this process will work from payer to payer, the one thing we all can agree on is this process will add time and energy to an already cumbersome process. CODE also knows that this is just the starting point.  Total joint replacements are the gateway to the entire orthopedic surgical population requiring PROs for prior authorization.

How can we keep the process classy and quick?

Prior authorization is making it more important than ever to have a good system in place for collecting PROs. When it comes to having patients complete paperwork in-clinic, anything quick and easy is a win. Here is the good news…at CODE we are passionate about helping our Clients collect, use, and LOVE PRO data. We have awesome ideas for how we can help your team with a quick fix for prior authorization that is minimally disruptive to work flow, and more importantly, teach you how to incorporate this valuable outcome data into your practice to improve quality, increase shared decision making and so much more.

Prior Auth doesn’t need to be a hurdle – CODE makes it just another step you don’t have to worry about.

Please reach out to us at CODE so we can help you work through this new process. CODE is like a prior authorization bodyguard. Step aside and let us work.

About the Author

Breanna Cunningham

Breanna Cunningham

Breanna is the founder & CEO of CODE Technology. Prior to founding CODE, Breanna spent 8 years as a Registered Nurse, where she worked in both the Trauma ICU & hospital administration.

breanna@codetechnology.com