Why is training for prior authorization of advanced radiology imaging important?

Most non-medical staff designated to do prior authorization for advanced radiology(MRI, CT, PET scan, nuclear medicine) are not trained. Due to staff shortages and administrative cost cuts, non-medical staff are tasked with performing prior authorizations. An internist, Dr. Hoffman from Oregan, in a recent article posted in the American Medical News, stated, "a recent Health Affairs article put the problem into perspective with a report that each U.S. physician spends, on average, $70,000 each year resolving insurance-related issues". Specifically, the prior authorization process can be confusing, especially for non-medical staff. Providing incorrect clinical information, the lack of clinical information and incorrect CPT codes, just to name a few of the many errors I have witnessed with medical office staff as a former nurse reviewer, can easily lead to delays and denials.

What does the future hold for prior authorization of advanced imaging?

In the ongoing debate about the public healthcare option and President Obama's proposed plan, there remains the question of what will happen with prior authorization.
From the many articles recently released, it does not appear that it will go away anytime soon. An article from Mass Device, written by E. Berger, Aug 2009, states "The healthcare reform legislation working its way through the Congress seems likely to include a proposal to establish (for Medicare or any publicly managed program) Radiology Benefit Managers(RBMs) organizations which would review and approve the appropriateness of referrals for advanced imaging". Another article, RBMs Are Part of Obama Plan from Radiology Today also describes how prior authorization for advanced imaging may be included. This initiative, if passed with the healthcare bill, will make prior authorization for advanced imaging(MRI, CT, PET scan, nuclear medicine) even  more of an issue for medical offices.

Welcome to Training for Prior Authorization of Advanced Imaging

Welcome to my blog! My name is Theresa Richards. I am a nurse consultant for Rosewood Consulting, a company I created to train staff how to perform prior authorization for advanced imaging (MRI, CT, PET scan, nuclear medicine).This blog was designed to provide information and tools for prior authorization of advanced imaging.