When MCO red tape creates barriers to care’

Jeff Milburn, CMPE, often hears complaints from the physicians in his 60-physician multispecialty group, Colorado Springs Health Partners PC, about the various paperwork hassles and delays that they call "barriers to care." These "barriers" include waiting for preauthorization approvals from managed care companies before performing a procedure on a patient, or being on the receiving end of patient complaints about referral requirements that delay a patient’s access to specialists.

The solution at Milburn’s group: automating referral and preauthorization requests.

Colorado Springs’ MIS department is creating computer templates to allow nurses to fill out referral requests and preauthorization requests on the computer screen and send them to the managed care organization electronically or via fax, Milburn says. "We’re going to assume it [the request] has been handled unless we hear back. If they [the MCO] want more information, they’ll call," Milburn says."

For referral requests, staff members will tell patients they should receive their referral authorization slips from the payer by the end of the week. Because Colorado Springs is a mature managed care market, most specialty practices require an authorization slip or number before a patient can book an appointment.

Milburn hopes to put the system in place in March, and have it ready for use two to three months after that.

For more information, contact Jeff Milburn at (719) 475-7700.

[Editor’s note: In this new series, Physician’s Managed Care Report will present a common dilemma providers face in working with managed care, along with a perspective on how one practice has chosen to deal with this issue. We welcome reader submissions for suggested topics. Contact Francine Wilson at (404) 262-5416 by phone, or via e-mail at francine_ wilson@medec.com]