Re: how do you handle referrals and preauth?

[Guest guest]

Is your concern the work load, or the

uncompensated work, or both? Maybe you could have them come in for an

appointment with you to do the referral/pre-auth?

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of Sofia Fernandez, MD

Sent: Wednesday, October 22, 2008

9:14 AM

To:

Subject:

how do you handle referrals and preauth?

SO I have been in business for about 17months now and

I am still

holding tight with myself and a FT LPN. I just hired a PT receptionist

for 16 hrs a week to help on the busier days, but I am still having

issues with all the paper work. I cannot " cut off " all insurance yet,

since I am still growing, but it is getting crazy here! The phone rings

off the hook at times, everyone needs a referral or pre-auth(even if

they have a PPO-grrrr) and we are getting swamped with work. I am

having my LPN train my new receptionist to help with the referrals and

I have changed my office policy to let the pts know they need to give

us at least one week to process the referrals and auths.

Despite my efforts, the patients are getting more demanding. I don't

want to annoy my patients, but I am a micropractice and that message is

NOT seeping into their heads. I don't know what else to do. I cannot

afford another FT staff member. Help! How do you do it?(specially those

who work in NJ).

[Guest guest]

Hi I am in N.J. (dead zone).

You may want to personally see some of these patients who request referrals, and can also bill for an office visit. It may require an effective triage person to decide how to arrange this diplomatically. As someone on the listserve mentioned this before, it is very enlightening to patients (especially the enabled ones) when calling the insurance company (try to do it over a speakerphone) on trying to get something preauthorized - spending this type of "quality" time empowers them, and they will respect your time also. While on hold you can discuss other issues. Let the insurance company know that you have the patient present for this process.

Subject: how do you handle referrals and preauth?To: Date: Wednesday, October 22, 2008, 11:14 AM

SO I have been in business for about 17months now and I am still holding tight with myself and a FT LPN. I just hired a PT receptionist for 16 hrs a week to help on the busier days, but I am still having issues with all the paper work. I cannot "cut off" all insurance yet, since I am still growing, but it is getting crazy here! The phone rings off the hook at times, everyone needs a referral or pre-auth(even if they have a PPO-grrrr) and we are getting swamped with work. I am having my LPN train my new receptionist to help with the referrals and I have changed my office policy to let the pts know they need to give us at least one week to process the referrals and auths. Despite my efforts, the patients are getting more demanding. I don't want to annoy my patients, but I am a micropractice and that message is NOT seeping into their heads. I don't know what else to do. I cannot afford another FT

staff member. Help! How do you do it?(specially those who work in NJ).

[Guest guest]

I should have specified. This is the work generated AFTER the ov. Many

tests are needing a prior authorization these days including echos,

u/s and stress tests. Don't even get me started on the allergy meds!

I guess my concern is the added work. I wish I could spend the time

doing it during the office visit, but sometimes I see people back to

back and it just isn't possible.

Any other thoughts?

[Guest guest]

This is one of the biggest differences between practicing in the

good old days and now. This stuff just did not exist at all in the past

when I started in practice. The cost to us of processing these

authorizations is one of the big reasons we are having trouble making

it financially now compared to in the past. Short of eliminating the

process altogether, another thing that might help would be some sort of

universal referral auth form that the insurors would be required to

accept similar to the universal claim forms they have to use and a

central clearinghouse for submitting and distributing them. EDI for

insurance auths. At present, each insurance company has their own

requirements which are different than every other insurance company's

requirements and are a constantly changing moving target. It makes it

difficult to use a computer to help you collect the data and submit

it. I believe it is not by accident that they do this, as the

beaurocracy and administrative delays cause an automatic form of

rationing and help hold down their expenses and make US the fall guys

with the patients for all the blame and frustration when things are

delayed.

>

> I should have specified. This is the work generated AFTER the ov. Many

> tests are needing a prior authorization these days including echos,

> u/s and stress tests. Don't even get me started on the allergy meds!

>

> I guess my concern is the added work. I wish I could spend the time

> doing it during the office visit, but sometimes I see people back to

> back and it just isn't possible.

>

> Any other thoughts?

>

[Guest guest]

We charge a $25 administrative fee for referrals (good for up to a year)

or medication pre-authorization (good for up to 6 months).

The fee solved all of the problems. Most patients accepted it happily;

strangely, in fact, many THANKED us for charging. It seems patients like

the control of being able to order it, and they appreciate the prompt

and cheerful service we can now give (thanks to the small adminstrative

fee).

The fee helps to keep us solvent and it eliminates the chaos.

[Guest guest]

Do the insurance companies we contract with have any provisions to

prohibit charging a fee for authorizations? I can't remember

reading anything one way or the other in the fine print. But must

admit, I didn't read all the fine print. I would guess they might

not be too pleased if they catch wind of it, but I really don't know,

just speculating.

>

> We charge a $25 administrative fee for referrals (good for up to a

year)

> or medication pre-authorization (good for up to 6 months).

>

> The fee solved all of the problems. Most patients accepted it

happily;

> strangely, in fact, many THANKED us for charging. It seems patients

like

> the control of being able to order it, and they appreciate the prompt

> and cheerful service we can now give (thanks to the small

adminstrative

> fee).

>

> The fee helps to keep us solvent and it eliminates the chaos.

>

[Guest guest]

Dear Chirag,

As posted on a separate thread just now, the insurance companies might

not like it. However, as many others on this list have just pointed out,

you can simply make it voluntary and give the patient the option to come

in and pay a copay instead.

Cyrus

Posted by: " Chirag Patel " cpmwu2000@... cpmwu2000

Thu Oct 23, 2008 12:19 pm (PDT)

Is it legal to charge for referrals/prior auths?

[Guest guest]

Dear Chirag,

As posted on a separate thread just now, the insurance companies might

not like it. However, as many others on this list have just pointed out,

you can simply make it voluntary and give the patient the option to come

in and pay a copay instead.

Cyrus

Posted by: " Chirag Patel " cpmwu2000@... cpmwu2000

Thu Oct 23, 2008 12:19 pm (PDT)

Is it legal to charge for referrals/prior auths?

[Guest guest]

Dear Chirag,

As posted on a separate thread just now, the insurance companies might

not like it. However, as many others on this list have just pointed out,

you can simply make it voluntary and give the patient the option to come

in and pay a copay instead.

Cyrus

Posted by: " Chirag Patel " cpmwu2000@... cpmwu2000

Thu Oct 23, 2008 12:19 pm (PDT)

Is it legal to charge for referrals/prior auths?