Intervention Insights CEO: 3 ways to reform prior authorization processes

Nearly one year ago, Intervention Insights launched its Trapelo platform to help oncologists make treatment decisions using real-time, evidence-based information. 

Intervention Insights CEO Clynt Taylor recently shared his insights with Becker's ASC Review on what reforms should be made to prior authorization processes:

1. Collaboration. Payers and providers should work together and align around a single set of current and comprehensive evidence-based data that is integrated into the workflows of both parties and accessible in real-time.

2. Evolve from prior authorization to transparency. Instead of requiring a 'mother-may-I?' approach for every case, allow payers to see that the ordering of tests is in alignment with evidence-based standards, and then engage only when a test is ordered outside of standard of care.

3. Management by exception. The management by exception process eliminates the prior authorization work for 90 percent of cases ordered in accordance with nationally accepted standards through published clinical evidence. And it limits the effort to only the 10 percent or so of cases that are not evidence-based.

Mr. Taylor also discussed how practices should make those reforms happen:

1.  Lead the way. If practices stand back and wait for a solution to come to them, it will come in the form of traditional prior authorization. If they get out in front of the curve on this, payers will come along.

2. Innovate. Practices must be the innovators. Quickly adopting clinical decision support tools sends a message to payers that, armed with the latest, most comprehensive information in the appropriate use of precision medicine, they don't need to be micromanaged. By standardizing the use of precision medicine across their practices, they are leading the way towards reforms that are good for patients, good for payers, good for labs and good for doctors.

More articles on coding, billing and collections:
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3 tips to manage claims denials at ASCs

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