The Journal of the American College of Radiology reported in June 2011, "It is estimated that 28% ($182,066/$640,263) of the projected RBM-related savings are shifted to providers." Ask any medical provider and I am sure they will tell you that this was no surprise to them. The burden of cost to hire and train staff to perform prior authorization for advanced imaging is placed on the medical provider. This cost is even shifted to radiology centers. If the test or procedure scheduled did not have prior authorization or a test requires upgrading, it is up to the facility to obtain that prior authorization. We all know it is extremely difficult to get reimbursement for a test or procedure for which prior authorization was not obtained first. And what about the cost to the patient in the delay of treatment or denial of a test or procedure? All costs that someone had to burden.
So how do you cut those costs that you have now been burdened with? You train your staff to become better informed about the prior authorization process, become more efficient in the way you perform prior authorizations and properly train your staff to provide accurate clinical to the RBM to reduce delays and denials.