OSI Article on Pharmacy Prior Authorization Published in BC Advantage Magazine

by | Last updated Jul 4, 2023 | Published on Mar 27, 2020 | Insurance Verification

Article on Pharmacy Prior Authorization
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Outsource Strategies International is pleased to announce that BC Advantage Magazine has published their article titled “Pharmacy Prior Authorization – Challenges and Solutions” in ISSUE 15.2., March/April 2020.

Pharmacy prior authorization (PA) is the preapproval process that the patient’s health plan requires for certain prescriptions before they will cover it. A December 2018 survey by the American Medical Association revealed that, despite efforts being made to resolve administrative burdens and provide timely care, PA poses significant challenges for both physicians and patients.

In this context, OSI’s article discusses the challenges associated with the process for approval of high-cost specialty medications and certain medical services. The author, Natalie Tornese, CPC, OSI’s Senior Solutions Manager, Practice and Revenue Cycle Management, Healthcare Division, also explains why PA is burdensome for practices and how it can be better handled. Natalie is in the expert contributors list in the current issue of BC Advantage Magazine.

The specific topics discussed in this comprehensive article include: why health plans require prior authorizations, 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 why a patient’s PA request may not be approved. The article also provides insight into appealing rejected claims. The author also explains the role of insurance authorization services in easing pharmacy PA by verifying patients’ benefit information before the office visit for clean claim submission and working with payers to speed up approval of PA requests.

Established in 2002, OSI is an experienced healthcare business process outsourcing company based in the U.S. offering medical billing and coding services for all specialties. The company’s comprehensive insurance verification and authorization services help practices avoid denials and payment delays. OSI’s expert team is knowledgeable about government and private payer rules.

BC Advantage is an industry magazine and online CEU Center for medical coders and billers, healthcare auditors, practice managers, compliance officers, and clinical documentation experts.

“Pharmacy Prior Authorization – Challenges and Solutions” is the fourth OSI article published by BC Advantage Magazine. The other OSI articles that appeared in this prominent publication are: “Tick and Lyme Disease Diagnosis and Treatment”, Viral Hepatitis – Types, Symptoms, and Diagnosis Codes” and “How to Code Screening and Diagnostic Colonoscopy”. The magazine’s medical coding article section also features two articles published on OSI’s website: “ICD 10 Codes for some of the Worst Epidemics in the U.S.” on February 19, 2020 and “Thanksgiving-Specific Foodborne Illnesses – Types, Symptoms, and ICD-10 Codes” on November 26, 2019.

  • Natalie Tornese
    Natalie Tornese
    CPC: Director of Revenue Cycle Management

    Natalie joined MOS’ Revenue Cycle Management Division in October 2011. She brings twenty five years of hands on management experience to the company.

  • Meghann Drella
    Meghann Drella
    CPC: Senior Solutions Manager: Practice and RCM

    Meghann joined MOS’ Revenue Cycle Management Division in February of 2013. She is CPC certified with the American Academy of Professional Coders (AAPC).

  • Amber Darst
    Amber Darst
    Solutions Manager: Practice and RCM

    Hired for her dental expertise, Amber brings a wealth of knowledge and understanding of the dental revenue cycle management (RCM) services to MOS.

  • Loralee Kapp
    Loralee Kapp
    Solutions Manager: Practice and RCM

    Loralee joined MOS’ Revenue Cycle Management Division in October 2021. She has over five years of experience in medical coding and Health Information Management practices.