Revenue Cycle Pain Points: The Prior Authorization Headache


If you answered yes to any of the questions above, you're not alone. Prior authorizations are a common pain point for many healthcare providers and medical practices across the United States.

We all agree that prior authorizations are a huge headache. And if you view the prior authorization process as burdensome and you're tired of spending a significant amount of time & resources on prior authorizations, it's time that you did something about it. If you're ready to say goodbye to the prior authorization headache, this on-demand webinar is for you.

This informative webinar discusses the growing prior authorization headache and shares solutions on how you can reduce the number of hours and resources spent on prior authorizations. And watch the entire webinar to learn the best solutions for receiving faster approvals with fewer headaches. 

The webinar will teach you how to:

  • Stop losing money due to prior authorizations
  • Simplify the prior authorization process and receive faster approvals
  • Decrease duplicate efforts on the same prior authorization request
  • Spend less time on hold and more time with actual patients

Jason McDonald (Head of Marketing, Meditab Group)
Jason is a senior healthcare tech executive with over 10 years of experience in medical billing, RCM & revenue growth.

I see we have a good sized group today for the Webinar and I want to thank you all for joining. We have got just about 4 minutes until the Webinar begins so we will hang tight for a few more minutes. Thank you everyone.

Jason: Hello and Welcome to our Webinar entitled, “Revenue Cycle Pain Points The Prior Authorization Headache.” My name is Jason McDonald. I am the head of Marketing at the Meditab Group which includes Meditab, DrCatalyst and a few other companies in the healthcare space. I have over 10 years of medical billing, revenue cycle management and revenue growth experience and I am very excited to share some of that knowledge with you today.

 During today’s webinar, I will reveal prior authorization, pain points and explore solutions that allow you to get prior authorization approvals faster, easier and more cost effectively. By the way, I know that today we have several different roles attending the webinar including doctors, office managers and front desk staff members so I want to let you know that this Webinar will provide knowledgeable tips and information for all of you.

However, before we get started let us go over a few housekeeping items. During the Webinar, everyone will be on mute. If a question pops into your head during the presentation, please submit your question in the question chatbox. You do not have to wait until the end of the presentation to submit your questions, just submit them right away so that you do not forget them. Then, at the end of the Webinar presentation we will do a question and answer segment and we will answer your questions and if for some reason we do not have time to get to all your questions because we do have a pretty sized group, then we will make sure that you receive an answer to any of your questions after the Webinar. We will get in touch with you via email, okay. Also, the Webinar is being recorded and we will provide you with access to the recording following the Webinar. So let us go ahead and get started.

So, in a few slides I am going to share some valuable tips and tricks that we have learned from tens of thousands of hours of prior authorization phone calls. These tips and tricks will help you be more efficient when dealing with prior authorizations. But first, let me paint a picture about some of the challenges that practices like yours and patients are facing when dealing with a prior authorization’s dilemma. The toll of prior authorizations is rising. Many physicians are feeling the impact of the prior authorization process and they feel as if it is continuing to get worse. In fact, 86% of physicians feel as if the prior authorization burden has increased over the last 5 years and 92% of physicians report that prior authorizations can have a negative impact on clinical outcomes. Also one third of practice as employee staffers who spend every second of their working hours on prior authorization requests and followups.

 Many of you already know a lot about prior authorizations. In fact, you probably know way more than you wish you knew so for the sake of definitions, what is a prior authorization? A prior authorization is required in order for you to get paid on certain claims for procedures and medications and while many of you already know about the headaches that are associated with obtaining prior authorizations it may actually be a surprise for you to learn about the impacts of prior authorizations on the revenue cycle. In fact, did you know that it is one of the biggest reasons for loss of revenue among practices in the United States. That is a huge problem.

 So, now that we understand how big of a burden prior authorizations are on the lives of physicians, office staff, patients, the question we must answer now is how can we fix the problem? What can we do to ease the burden? Standby for a little bit more information about prior auths followed by some ways to improve the prior authorization process in your medical practice. It is common for physicians to face prior authorization burdens for new or unusually expensive medications or test but more recently insurers have rapidly added PA requirements to more and more treatments and procedures and this makes the process even harder to complete. PA rejections and other complications cause delays that affects your delivery of care. This means that patients do not get the treatment or the medication they need on time. Your workflow takes disorganized bends and turns and of course you do not get paid on time. Prior authorizations are a major burden. In fact when physicians were surveyed about the average prior authorization wait time for them and their staff, the results were staggering, 64% reported waiting at least 1 business day and 3% reported waiting at least 3 business days. These long wait times lead patients untreated, tie up phone lines, require a significant amount of time from staff members, put patient in a situation where they tend to blame physicians plus more, and according to a new survey by the American Medical Association, prior authorization issues are associated with 92% of care delays and they may contribute to patient safety concerns as well as administrative inefficiencies. I like to use this example. The next time you pass by the waiting room at your practice, look at the patients sitting there. If 10% of those patients needed prior authorization approvals then out of those 10, 9 of them would experience some of type of care delay due to prior authorization approval. In other words, 9 out of 10 patients could potentially receive a care delay, that is pretty unbelievable, right? Additionally, on average a medical practice will complete 29.1 PA request per physician per week which takes 14.6 hours to process and about half of the request are for medical services, all the other half are for prescriptions. So basically the amount of time that should be spent taking care of patients is now used to do follow ups for prior authorizations which ultimately delays patient treatment. We see also that PA is rarely on time so practices often experience unwanted delays in care and that is in addition to a handful of other challenges which include loss productivity, additional operational cost, workflow disruptions, delayed payments, clinical personnel dissatisfaction, bandwidth constraints, slow turn around time, decreased quality of care, poor staff morale, turnover and the list goes on and as you all know the process of obtaining prior authorization can be a lengthy administrative nightmare of recurring paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt the patient’s access to vital care. The percentages of patients that tend to abandon their treatments because of PA delays are alarming, only less than 20% do not abandon. This leads to poor outcomes and on your part lost revenue.

 Now that you have a better understanding of the growing prior authorization burden, I would like to share a few prior authorization tips and tricks. We actually have a team of 250 clinical nurses that make phone calls day in and day out to capture prior authorizations for our medical practice customers and then we enter them directly into the EHR system of the customer. So we happen to know a thing or two about how to successfully process prior authorizations and we want to share those tips with you so here we go. First, when you call a claims adjuster for the first time and they do not pick up, leave them a voice mail with your name, claim number and the requested procedure and call back number. Then immediately after you leave the voicemail and hang up, call them right back because sometimes you will actually reach that person. Also if you have several patients that have the same insurance provider, group them together and be prepared to give the insurance company all of the information on 1 phone call rather than calling back for each additional patient, this is a great tip that will help you save a lot of time. Often times, the guidelines for insurance companies can be very tedious and complex, therefore make sure that you understand each insurance company’s guidelines before you submit a prior authorization request. Finally, figuring out the request forms can be a nightmare and very time consuming so to help with the process try prefilling the request forms with recurring office and provider information. While the typical prior authorization request process is time consuming, challenging and very frustrating, these are a few tips that can help make the process a little bit more manageable for you and contrary to what you might expect solving the prior authorization problems is not such a monumental task.

 We are going to look in to the top 3 solutions that are proven to relieve or even cure your PA headache, although not all of them are optimal and cost effective. Training and expanding your current staff improves your efficiency, enables them to work around problems quickly but it is costly and time consuming so while you might have the budget to do this, your busy day-to-day operations may make it so that you can never actually have the bandwidth to accommodate training sessions in your workplace. Using an EHR system to manage prior authorizations is also a proven immediate solution but do you what to know what makes it even better? A dedicated remote staff that handles your EHR for you.

 Let us explore the outsourcing solution a little further. Outsourcing staff is a solution that many practices are currently turning to and remote staff members can actually be particularly helpful when it comes to the prior authorization process. In the event you need help with processing and completing your prior authorizations, DrCatalyst is here to help you. Have you ever wished you had 250 clinical nurses that could drive your EHR? We are actually doing that now for over 100 medical practices across America. This helps to free them from the administrative nightmare of modern day medicine so that they can spend more of their time with patients and less of their time with paperwork. We can work with any EHR to streamline your office work flow. Additionally, with our EHR expertise we offer a number of clinical administrative and billing services to help you eliminate the problems that are caused by prior authorizations. We can take care of prior authorizations for you very cost effectively so that you can care for your patients.

 Let me share a few of the ways that DrCatalyst can serve as a valuable partner in your medical practice. For starters, DrCatalyst’s 250 plus clinical nurses can call the insurance carriers for you and complete the insurance eligibility verification process and then if the insurance company requires an authorization, they can do that on the same phone call. This will free up your front desk so that the office staffs can spend time doing more valuable things like taking care of your patients, we know that is the most important thing for you.

 DrCatalyst can also handle your RCM and medical billing needs. We can enter and submit charges. We can make accounts receivable followup calls with the payers and post payments from ERAs and EOBs and to your billing software or maybe you just want help with some of the process. You could pick a number on the screen and we could help you with just that part of the process that is the biggest headache for you.

 DrCatalyst also offers services that can handle everything from front and back office operations, so a few of the standout services include document and fax management where we can label and assign your incoming faxes to the correct office staff so that there is no delay in patient care or communication with other medical practices like referring physicians. Additionally, chronic care management will actually help you set up a chronic care management program. Chronic care management is a service that Medicare reimburses an average of $50 per month per patient for you making a 20-minute phone call to your patient so that is something that we can help you with. Those are just a few of the services that we offer but truthfully that does not even begin to scratch the surface of the number of ways we can actually help your medical practice.

 We also create personalized marketing solutions for practices. We recognize that each healthcare practice has different marketing needs and that is why we tailor-make marketing strategies to fit your preferences. Honestly, the power of marketing is huge. Just think about it. When your practice is found by more patients and you have a positive online reputation, then your practice will begin to grow, so let us help you.

 We provide marketing services in the following areas, Website design. We can create a custom website from scratch; search engine optimization so that Google and the search engines can find your website easier. We also do patient phone surveys and we help get you Google reviews online. So regardless of your specialty, DrCatalyst can provide you with cost-effective, high quality marketing services.

 On the next few slides, I am going to show you some examples of the websites that we have created for some of our customers. This website was for an orthopedic client, NORA, and we created a nice customized and personalized website and what is so great about this website is that it highlights the orthopedic specialty. It is also user friendly and it caters to the patients by allowing them to easily make appointments, fill out patient forms and many other things.

 We have also built and designed websites for women health clinics such as this one for Dr. Anoina. We have also created a website for one of our clients that focused on OccMed services. On their website you can learn more about their services, get healthy tips and download patient forms. We have also created and optimized websites like this one for clients in the allergy and asthma fields.

 In addition to website design as I mentioned earlier, we can help you get more positive Google reviews from your patients. Look at the end of the day, every business has gotten a bad review at one time or another. If you have a bad review do not let that get you down or worried instead work with us to ensure that your online reviews are handled with care. That is what DrCatalyst is all about, whether you are providing services to make your authorizations, you know, more streamlined or helping you build your brand through our marketing services, we are here to help.

 Now, let us switch gears a little bit and look at how the EHR and billing software should be configured to meet your demands on the authorization process. Think of this as a handy checklist for what you really need to think about on the authorization side when you select the billing and EHR software. If you oversee or work at a practice, you probably experienced night sweats when it comes to dealing with prior authorizations. If you are spreading your staff in an attempt to submit prior authorization request in a timely manner, an EHR and billing solution can help.

 Your EHR and billing software is where you track your prior authorizations, so it is critical that you choose an EMR and billing software that adequately meets your prior authorization requirements. So, I just want to share a short checklist of the things that a leading software should be able to help you and your practice do on the authorization front. First, the software that you select or use should be able to track the number of visits allowed when an authorization is approved. Additionally, your software should be able track which CPT and ICD codes are allowed with that authorization. So, as we all know these codes are the way that physicians and payors communicate. Don’t you think that your EHR and billing software should support that, of course. So really it is important for several reasons but one of the main reasons is because it can help your practice if there is ever a payment dispute. Thanks to these 2 codes your practice will have assurance that the procedure will be paid by the payor since the code gives them the approval to do so.

 In general, there are a ton of prior authorization request that are made each month, and honestly, it is not that easy to check on each individual request. And that is one of the benefits of an EHR and billing software. It can help you keep track of your approved prior authorizations and keep tabs on them when they expire. It would be better if your software has a filtering system that helps to speed up the process of finding out which authorizations are about to expire and having a filtering system could also benefit patients because the staff members at your practice would then be able to see which authorizations are about to expire and they can prioritize them accordingly. The last item on the checklist, is to make sure that your EHR and billing software allows you to add important patient data into a form. Now, most billing software allows you to fill out forms, print and then fax them to the appropriate payor. This is the basic functionality of a billing software. A more advanced option would be a system that allows automation and an auto-population functionality. As you can tell, EHR and billing software can be a very valuable tool in the prior authorization process. Now that you have a good idea of how EHR and billing software can help with the prior authorization process I want to share with you a leading EHR and billing software that checks out every feature mentioned on the checklist and more. By sharing this, I want to give you some ideas about the ways the you can leverage your own EHR. Some of these features should already be included with your EHR, and maybe you did not know that they existed, so make sure that you keep notes here and make sure that you contact your vendor or you can find a vendor that offers these specific features to make you much more efficient. Meditab and IMS have been around and thriving for over 20 years. And honestly, in this industry that is no easy feat and throughout those 20 years, Meditab has helped many physicians have successful practices. From allergy clinics to fertility centers, what is so great about Meditab software is that it is able to adapt to every medical specialty. Meditab understands that practices come in all shapes and sizes and that is why in addition to IMS’s veteran status, it is customizable and it can adapt to the workflow of every practice, no matter the size or the specialty of that practice. Oh and did I mention that IMS is able to automate the prior authorization process? Thanks to its authorization tracking module. It can make the prior authorization process for your practice more efficient, more manageable and far less time consuming. But honestly, you do not have to take my word for it. Surely, I will personally show you IMS’ authorization tracking module and explain how it can improve the prior authorization process and your practice. DrCatalyst 250 remote nurses are also very knowledgeable about IMS. In fact, everyone of them is certified IMS users. So, you can utilize the nurses to drive your EHR and take the lead on improving their prior authorization process at your practice. Now as promised, let us take a little bit closer look at IMS’ authorization tracking module. Using IMS authorization tracking module is so simple, yet very effective. Basically, in three easy steps you can add all of your patient’s information into a form or a letter template and then you can submit it to the appropriate payor. After you select the patient in IMS, you simply choose the form or letter template that you want to be filled out. Click the form fill button to auto generate all of the patients information into the form and then you submit the form or letter template. You can either choose to automatically fax it or you can print it and save it. How easy is that. Three simple steps and you have a completed prior authorization request. I know that most of you are probably like me, a visual learner. So now, let us take a look at how the process would actually look in the IMS system. Let us say that you want to fill out a prior authorization and request for a patient John Doe. Once you log in the IMS, you can go to the authorization tracking module and once in the module you will see that the screen houses all of your patients. You will then locate John Doe. Now after you locate his name, click on the paper icon with the check mark. That is the prior authorization form icon. Once you click on that icon, a pop-up box will appear with a list of prior authorization forms. Select the appropriate one. After you select the proper form, click fill form. In this instance, we want to fill out a United Healthcare form for John Doe. Next is where the auto generated magic is going to happen. Once you click the fill form button, the patient’s information will be auto generated into the form. So essentially, with just the click of a button, you can have all of your patient’s information at a tool form. This means that the days of manually inserting all the patient’s information in the forms is behind you. Just think of how much time you and the others at your practice will save. Now, once the patient’s information has automatically populated into each field, you can automatically fax the form to the appropriate payor. Yes! I said automatically. I know, it is a foreign word when it comes to prior authorizations, right? But IMS is aiming to change that. Now once you click the fax button, it is going to take you to this screen. Just confirm the patient’s name, the referral source and the insurance company information, then you can have the document automatically faxed over. The fax automation, is one of the things that really stands out about IMS. Honestly, IMS makes the prior authorization request process super easy, from filling out the prior authorization form to actually sending the form off to payers. IMS helps you streamline the entire process. The best part about it is that this process usually takes 5 to 10 minutes for each request. With IMS, it takes less than one minute. So there are several benefits to using an on demand staffing in EHR software. When it comes to demand staffing, DrCatalyst has been able to help clients with all the parts of the revenue cycle; from prior authorization approvals, to claims, to accounts receivable management. This is an example on the screen of our client, Asthma and Allergy of Idaho and Nevada. They were having outstanding billing challenges at the practice, and since joining as a client we have been able to help them resolve issues in different areas such as claims and accounts receivable. Here is another client, Columbia Allergy and Asthma Clinic has benefited from the fact that we always have remote staff members available for your needs. Also, this particular client enjoys the fact that the services that DrCatalyst provides are now very compatible with Meditab’s IMS solution. And as you saw during the webinar combining on-demand staffing, the 250 clerical nurses and the leading EHR system is a great solution for tackling the prior authorization headache that we have covered today. We know that the prior authorization process is quite frustrating and it is a growing problem. And honestly, there is no aspirin strong enough to relieve the prior authorization headache for being honest. However, with a good solution in place and a trusted partner by your side, you can make the prior authorization headache less severe. Let us help you with that. If any of you are interested in continuing this conversation, I suggest setting up a free consultation with our DrCatalyst team or arranging a live demo with our Meditab team so that we can help you overcome some of your prior authorization woes. On the screen you can see our phone numbers.

 Now, we would like to take some time to answer questions that anybody on the webinar has.

 Question #1: How do you deal with patients who have an insurance plan that requires prior authorization per consult. Everyday are new patient that they have not seen yet, therefore as a practice what do you recommend? So should I submit a prior authorization for the patient that they have not entered yet or ask the patient to request a prior authorization before their first visit? Most of the time, we do not realize that needed us a prior authorization per consult until after they file the claim, since our practice is an out of network provider. So basically, I think _____ just wants to know how do they deal with patients who have insurance plan that requires prior authorization per consult.

 Jason: Thank you Tiffany. Ariel, how does your team of clinical nurses deal with this scenario and I want to underscore something I think this is a great question and I want to thank the audience for all of your questions. Your questions help us to have dialog and collaboration with you and we absolutely love providing help. Ariel, I think there are two things in this question.

 When a new patient comes into the office and they have not been seen yet, how do we manage the prior authorization process and then Ariel, the second thing that I heard that kind of caught my attention was the fact that they are out of network. So my question to you Ariel would be is the out of network aspect does it change anything when it comes to prior authorizations when your team works on the prior authorization? So Ariel can you shed some light on this for us?

 Ariel: So with the first question that we have when a new patient would come into the clinic, it would be the referring physician who would get the authorization for that patient to be seen in the clinic practice. With the second question, when it comes to out of network, the best thing that we do for that is before we see the patient, we have to check first with the payor if we are allowed to see the patient and does the patient have other active insurance which we could see or we are in network with just to make sure we have to gather the eligibility and benefits for that patient.

 Jason: That is great, Ariel. So when we have a new patient that comes in, we want to call and verify benefits, right? And find out exactly what the coverage includes and if they are authorized to be seen by this physician for this procedure. Is that correct?

 Ariel: Correct. Otherwise, if the patient is not authorized to see the doctor then the patient will have to do a self-pay.

 Jason: Okay. Fantastic. Thank you, Ariel, for helping us and guiding us through that process. The next question is from Janine and I am sorry, Janine, if I mispronounce your name. Janine asks, should you go through the authorization tracking screen or go through the CoverMyMeds button? So Ariel, do you know how to answer that one for Janine?

 Ariel: So yes, I think this question is about the IMS. When it comes to the CoverMyMeds, it is what we call prior authorization for medication. We actually have a separate module for that in the IMS. That is what we call EPA. That is under the Activities. So, the tracking system for the medication is different from the authorization tracking. Mainly what we do with authorization tracking are the kind of procedures that can be done in office or should be referred out to another specialty. Now with the EPA that is directly integrated into the CoverMyMeds so there is a button there that when we click Start EPA that would link us to the CoverMyMeds and let us complete the questionnaire from the payer through the CoverMyMeds website.

Jason: That is great. Thank you, Ariel. Mia has a question. She says, in a lot of prior authorization request forms we need to input the diagnosis codes; however, this is not something we have until the doctor has seen the patient. How do we protect ourselves in the event that we see a patient to get necessary diagnosis codes before we have the authorization itself? Ariel, how would you answer that one?

Ariel: So, for us we have to review the first the report of the doctor just to confirm all the data entry or all the information are matching. So for example, the doctor requests this kind of MRI for the lower back and then when we see on the report of the doctor that the diagnosis is only for the cervical spine or the thoracic spine then we have to consult with the doctor about that before we submit a prior auth. So the keypoint there is review first the request before sending it out to the payor.

Jason: Okay. And I think, Ariel, if I understood the question I think she was saying that they have to put the Diagnosis codes into the prior auth but they do not know what the Dx codes are because the patient has not seen the doctor yet. So I am guessing Mia is in a practice that is maybe multispecialty and they have different types of procedures. Ariel, when you work with a new client and you do onboarding for them, do you ask them for a list of their common procedures so that the person that calls to get the authorizations can, kind of, narrow it down? Because they know it is going to be one of a couple types of procedures. Is that the idea?

Ariel: Yes, so basically what we do when we start with a new practice or a new client is we gather the common CPT codes that they submit to the payor so that we know what are the things that we have to look into in the Visit Note. So with Mia’s question on the diagnosis prior to the patient being seen in the clinic is that I think it is better that we submit the request after the patient has been seen by the doctor. That way we can determine what is the diagnosis that should be linked to that procedure code.

 Jason: The challenge with that, of course, Ariel, is that the practice might see a patient and then not get reimbursed for it. I think what Mia is asking is, is there a way to avoid that? And I know that when you take on new customers one of the things that you do is you ask for commonly-seen procedures for that practice. This is not always possible because like you said and like Mia said, we do not know what the procedure is going to be until the doctor actually sees the patient. However, in some practices if the patient calls and says, “This is my symptom” and if it is a practice that does five types of procedures and one of those procedures fixes the symptom that the patient expressed on the phone, I think then you could call and get a prior auth for that and if you get a prior auth for that and then the doctor sees the patient for something different then of course I think you have to deal with it at that point, but maybe this is one way that Mia could protect the practice. So what she might do, and I want you to tell us, Ariel, if this is a smart strategy. Could she ask the doctor for the most common list of CPTs that he typically does with patients and then create a little bit of a map that when a patient schedules an appointment for this problem usually this is the procedure for it?

 Ariel: I think it is not advisable to do that because we are trying to create a diagnosis which is not yet indicated by the doctor. So the best thing that we can do for that is after the procedure, after the consult we can then submit a retro request for authorization, so that means the procedure is done before we submit the request for the approval from the insurance. Some payors would allow that kind of request so we have to check first with the insurance if they would authorize retro request for authorization.

 Jason: Okay. It looks like Mia actually gave us a follow-up question and I want to thank Mia for that. She said she is in a chiropractic office and they have patients that come in without a referral all the time and they cannot send in an authorization beforehand because they do not know what is going on until they have been seen. So she says what if we do not get the authorization but we had to see the patient to even attempt to get an auth?

 Ariel: So, the best thing that Mia can do with that is they have to contact the referring physician’s office. They have to get the approval first because it is the responsibility of the referring physician’s office to get the approval for the patient to be seen by a chiropractic practice. So Mia has to call the referring physician, get those authorization and other referral staff.

 Jason: But she said they have patients that come in without a referral all the time.

 Ariel: I guess the best thing that Mia can do with that is they have to check first with the patient’s insurance to see if the patient is covered with this kind of procedure so by the time that when they submit the claim or submit the retro authorization, then they can be paid since they have the proof that they have confirmed the eligibility and the benefits coverage for the patient.

 Jason: Exactly. So, Ariel, it sounds like what you are suggesting is always call and do a very good insurance eligibility verification with the payor, ask the right questions, right? And in a chiropractic setting I think you are typically doing a handful of CPTs. I could be wrong about this, Mia, but I think you are usually doing a handful of CPTs so you could call and see if the patient is covered for those things.

 Ariel: Correct.

 Jason: Okay, that is good. Thank you, Ariel, and thank you for your questions, Mia. These are great questions. The next question comes from Ashley. She says “I do not have a popup to choose from insurances. How can we have this set up?” My guess, Ariel, is that Ashley is using Meditab IMS so it sounds like she needs help setting up the authorization form letters. Ashley, if you are hearing me, could you confirm, is that accurate that you are an IMS user and you need help setting up the form letters? Let us assume the answer is yes, Ariel. Is there a good instruction we could give her on how to set those up?

 Ariel: With setting up the forms to be filled, that can be done in the setup but it is only the superuser who could do the setup for that. What they can do is they can contact their account manager in Meditab and have them schedule a training with one of the implementers so they can be trained on how to set up a form. That is a pretty easy process but it is the implementation who could directly give them the actual training to set it up.

 Jason: Fantastic. So Ashley, you probably know who your account manager is. If for some reason you do not, please let us know and we can make sure that your account manager schedules a time to get your implementation person to help train you on how to set this up, okay? It looks like Melissa said, and this may be a misspelling, I think it came across as M-E-L-I-S-S. Melissa said how do you get a prior authorization from the referring physician if they are a hospital? A lot of our patients are from hospital emergency rooms. Most of them do not realize they are out of network until they show up at our office.

 Ariel: Basically what the referring physician of the hospital will do is they contact the clinic, they are trying to see if the patient would be accepted with this kind of insurance and if for an example, the patient would come in and does not know that his insurance is a network with that provider, the best thing that they can do is try to check first quickly with the insurance to see if the patient is covered for that kind of procedure or consultation. Yes, that is the best thing they can do.

 Jason: I am not nearly as comfortable with the authorization process as you are, Ariel, but I wonder if the practice might communicate with the administrator or the manager of the emergency room and ask them if they might educate the patient that, you know, every practice is different and the practice may or may not be in-network or the patient’s insurance may not be covered by the practice. I wonder if the practice could contact the referring practices like the ER and just have good communication in place so that they could communicate that to the patient before referring the patient. That way the patient does not get caught by surprise when they arrive to Melissa’s practice.

 Ariel: Correct. And also with other referring offices what they do is they print out the referral documents, give it to the patient, instruct the patient that “Please give this office a call. They are going to see you for this kind of consultation.” Most of the practices or specialty clinics they do not usually _____ but they do schedule _____ that is the preventative way of _____ that are not in network with their practice. So yes, _____

 Jason: Ariel, you are having, I believe, some internet problems. I think you are cutting in and out a little bit.

 Ariel: I am sorry for that.

 Jason: It is okay. Maybe you could repeat the last part.

 Ariel: Yes, so the last part I mentioned was the specialist office like Melissa’s office, they have to communicate well the common referring office so that they can, for example, _____ this and then with that verified the insurance if the patient _____

 Jason: Ariel, maybe you could call in from a phone because you are cutting in and out. There we go, folks. Modern technology. I apologize. I think Ariel is having some challenges with his internet connection so hopefully he can dial in. I am sending him a text message so that he can dial in. So while we wait for Ariel, there is another question and I think Melissa responded that you have communicated to the hospital many times and they do not do a great job of educating the patients and so my feedback or counsel to you, Melissa, would be that maybe you could give a little bit of thought to the right communication process with those patients because we know that they are being sent to you from the hospital and they are just entrusting the hospital that their insurance would cover the visit with you. So perhaps that could be the very first thing you tell them. You could say, “Hey, you know, the ER is very busy and sometimes since they are so busy there is a chance they refer patients to our practice and they are not always covered by our insurance so the first thing we like to do, Mr. Patient, is call the insurance company and verify your benefits.” Melissa, you may already be doing this and if you are, I think that is fantastic but if not, maybe spend a little bit of time thinking about how to communicate proactively to the patient and say, “Listen, you might not be covered and if that is the case, I apologize.” And then tell them that you are going to verify the benefits. I think that is one potential solution.

 And then we have another question from Jennifer. This is a great question. Jennifer asked, that is very helpful that forms and letter templates can be auto-generated in IMS. Can you explain the difference between forms and letter templates in IMS a little bit more? So Ariel will be rejoining. Ariel, are you back?

 Ariel: Hi, Jason. Yes, I am back. Sorry for that.

 Jason: Oh, it is okay. I know technical difficulties happen. So you heard the question from Jennifer about letter templates versus forms?

 Ariel: Correct. Yes. So, the main difference between the two is we use the form for specific--because what we know is commercial insurances have different designs on their forms. They have their logos in other stuff which is not that easy to copy when it comes to making a letter template. So what we do with that is we mainly use the forms to be filled for those kinds of documents and then with letter template we mainly use that kind of form to create a request for authorization form that can be set up in a Word format. The good example for a letter template would be the DWC RFA form or the Worker’s Comp Request for Authorization form in California. The design is more on tables only so it is pretty easy to copy that using a letter template. But with other insurances like United Healthcare, Blue Cross, Cigna, Aetna, and other commercial insurances, they have different designs so the best thing that we can do to automate the filling out of those forms is to use the forms to be filled. Last thing would be the output of the forms to be filled would be on a .JPEG or through .TIFF format but when it comes to the letter template the output document would be in a form of a Word kind of document.

 Jason: So a Microsoft Word versus an image file, right?

 Ariel: Image file, correct.

 Jason: Okay, perfect. Thank you, Ariel. Nicole asked us a really good question. She says, “What about the times when we call the insurance company and they say that no prior authorization is required; however, the claim is then denied because we did not get the prior authorization?”

 Answer: So, we also encountered those kind of situation. The best thing that they can do with that is once they contact the insurance and the insurance agent would say there is no authorization needed for this kind of procedure then they have to get a reference number. Reference number is like a call identification number wherein it would indicate that what time, what date did they call the insurance to verify that kind of procedure. So that way they can file an appeal on the claim that they made this kind of query from the insurance and they have this reference number and in that reference number it has a data on the insurance stating that one of the insurance agents spoke with this person from the clinic and the insurance agent stated that this procedure is no auth needed. So best thing to do is get a reference number.

 Jason: That is great. A reference number is such a good idea. That is wonderful. I think that wraps up our questions. To the moderators of the webinar it actually looks like--actually, it looks like we got another question. This is great. Here is Tina’s question. “You mentioned that DrCatalyst outsourcing services can work well with Meditab’s EHR system. Can you explain that a little more? Can you give me a good example on how it would benefit my practice to utilize both?” Tina, thank you so much for asking the question about how DrCatalyst can help with Meditab’s EHR. So the short answer is that any functions that your practice currently does that does not require an office staff member to work with the patient, so in other words, if it does not require an office staff to be in the office, everything else that you do in the Meditab software or when you are calling a payor or you are managing a referring physician or you are answering a phone or you are reminding a patient to come to the office, all of those other things are things that DrCatalyst can do. So, in essence, DrCatalyst can do a handful of different services. One, DrCatalyst can manage your incoming faxes. We can review every fax, label it and then assign it to the right staff member. It is funny, you know, fax machines are, kind of, like the heart of a medical practice and what happens is practices are so busy they cannot keep up with their faxes. So Ariel’s team actually manages incoming faxes. Ariel, can you talk just a little bit? I think Tina would like to hear this. Can you talk a little bit about how you manage incoming faxes that come in to IMS? You know, what process do you take? How do you assign them that kind of thing? I think that would be helpful for Tina.

 Ariel: Yes, Tina. So what we basically do in DrCatalyst is that we can come in like two hours ahead of your office work hours and we can then link those incoming faxes to the patient’s chart, put the category, the description, and then forward to someone in the office who would do the next process for that kind of document. In case that there is a problem on your faxes, technical issue, we can then directly communicate with the Meditab technical support since we are just a sister company. Communication with them is pretty easy so we can then have a quick fix to your faxes if that happens.

 Jason: That is great. Thank you, Ariel. And Tina, the other things that we can do for your practice--sorry, there is, kind of, a long list. Most of which are listed on the DrCatalyst.com website and we could schedule a time for you to have a free consultation from our team but in essence, we can do everything from the entire revenue cycle, we can make phone calls to insurance companies to get eligibility verification done for you, we can process the prior authorizations for you. With patients we can take incoming phone calls and act as a remote receptionist. We can call your patients proactively reminding them to come into the office. We even have physicians on our team that call patients and take prior medical history and enter it into the chart so that when the doctor sits down with the patient, the chart note, a lot of it is already done for them. So it simplifies the process and accelerates the delivery of care. So there is a lot of things that we can do and that is a really good question. Thank you for asking that, Tina.

 I think that may wrap up the questions that we have. To my moderator team, do we have any more questions from the audience? I think that does it. Wonderful. Well, thank you all. We had a wonderful time sharing the prior authorization problems and solutions with you all. We hope that this was helpful for everybody that attended. If anybody has any follow-up questions, we have a full team of people that can help you answer questions about how you can do this in your own IMS software or if you are using something different and you have questions about anything that you heard or you just want to get advice about how to do certain things, please do let us know. We are always here to help you. And there is a contact form on DrCatalyst.com. Additionally, you can call us anytime at these two phone numbers. The first number (510) 628-6005. That is DrCatalyst so call us if you have questions. If you need to speak with somebody at IMS Meditab call (510) 201-0130 and I am just sharing this because we had so many wonderful questions. We are here to help if you have additional questions, okay? Thank you, everybody. Have a wonderful day. That concludes our webinar.