Multiple authorizations for single procedures
While many payers required authorization for injectable procedures for some time, they’re now adding a new requirement.
“We are now receiving denials for failing to obtain authorization for the medication in those injections. This is something we had not seen previously,” reports Jeanette Foulk, director of patient access at Methodist Charlton Medical Center in Dallas.
Currently, patient access staff are seeing authorization requirements for chemotherapy injections that weren’t required previously, which leads to high-dollar denials, says Foulk.
“We are now informing the referring physician’s office to request a medication authorization code when obtaining the authorization for those procedures,” she says.