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    Prior authorization: Caught in an administrative nightmare

    No simple solution to preauthorization process that delays care, burdens clinicians


    Some doctors are charging patients for preauthorization services. Estimates are around $20 for each preauthorization. In a March 2017 online poll by Urology Times, 31% of respondents report passing along costs associated with prior authorization to patients.

    Also see - Telemedicine: Reimbursement in fee-for-service, quality models

    Jeffrey Kaufman, MDDr. KaufmanJeffrey Kaufman, MD, a urologist in Orange County, CA and past president of the AUA’s Western section, says his practice has not resorted to charging patients for prior authorization but has considered it.

    “We’ve discussed the ethics and morals of it. Patients understand,” Dr. Kaufman said. “If I call my accountant and ask him to call the IRS on my behalf, I expect a bill.”

    It’s reasonable, Dr. Kaufman said, for a patient to expect a bill if the doctor gets prior authorization for a treatment or medicine on the patient’s behalf.

    Still, that’s something that the urologists interviewed for this article have a hard time grasping.

    “The fact that physicians are considering billing for these services tells you that they are struggling, they are up against a wall, and they are feeling cornered that they have to make those kinds of choices to make ends meet,” Dr. Childs said.

    Long-term solutions

    The best shot doctors have at changing prior authorization is by lobbying at the state level, according to Painter.

    “Most of the activity on trying to curtail the burden of prior authorization is happening at the state legislative level. And most insurance plans are regulated by the states and licensed by the states,” Painter said. (Also see, “Inefficient payer approval processes fail patients, frustrate docs” at urologytimes.com/AACU.) Groups have tried to negotiate with the payers, but that doesn’t seem to work, according to Painter.

    “The best advice I can give is to get involved in the state medical association or the specialty medical association at the state level and work with them to develop laws within the state to reduce the burden on physicians,” he said.

    On a national level, the AUA is supporting the AMA’s “Prior Authorization and Utilization Management Reform Principles,” which includes 21 principles for reform.

    Read - Value-based pay in 2017: Where does urology fit?

    While the principles are fair and reasonable and may streamline the process, Dr. Childs said, physicians will continue to be saddled with time-consuming prior authorization requirements, even if the principles are accepted by insurers.

    Next: Non-profit hosts forum on prior authorization

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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