Outsource Strategies International is glad to announce that prominent industry magazine BC Advantage has published its article titled “Pharmacy Prior Authorization – Challenges and Solutions. Written by Natalie Tornese, CPC, OSI’s Senior Solutions Manager, Practice and Revenue Cycle Management, Healthcare Division, the article appears in BC Advantage Magazine’s March/April 2020 – ISSUE 15.2. Natalie is in the expert contributors list in this issue of the magazine.
Pharmacy prior authorization (PA), the preapproval process that the patient’s health plan requires for certain prescriptions before they will cover it, is a major concern affecting physicians in the United States. In fact, a December 2018 survey by the American Medical Association reported that, though efforts being made to address administrative burdens associated with PA and provide timely care, pharmacy preapproval continues to be a major concern for both physicians and patients,
OSI’s article provides a comprehensive overview of the preapproval process for high-cost specialty medications and certain medical services, and rationale underlying the prior authorization requirement. It also discusses the criteria for approval of a drug undergoing the PA process, the types of drugs subject to PA, the PA process, and the common reasons for denying a patient’s PA request. The author also explains how PA is burdensome for practices and how it can be better handled, as well as the process of appealing rejected claims. The role of insurance verification and authorization services in easing pharmacy PA is also discussed.
A US based healthcare business process outsourcing company with extensive experience, OSI offers medical billing and coding services for all specialties. The company’s insurance verification specialists ease PA challenges faced by physicians by verifying patients’ benefit information before the office visit. They also work closely with government and private payers to help practices avoid payment delays and denials.
BC Advantage Magazine is a highly acclaimed CEU approved national online healthcare publication and the largest independent resource provider in the industry for medical coders and billers, healthcare auditors, practice managers, compliance officers, and clinical documentation experts.
In addition to “Pharmacy Prior Authorization – Challenges and Solutions”, the other OSI articles that BC Advantage Magazine published include: “Tick and Lyme Disease Diagnosis and Treatment”, Viral Hepatitis – Types, Symptoms, and Diagnosis Codes” and “How to Code Screening and Diagnostic Colonoscopy”. The magazine had also featured two reports by OSI in its online medical coding article section: “Thanksgiving-Specific Foodborne Illnesses – Types, Symptoms, and ICD-10 Codes” on November 26, 2019 and “ICD 10 Codes for some of the Worst Epidemics in the U.S.” on February 19, 2020.