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Resolutions seek to limit pre-authorization burden on practices

Imagine a system that allows providers to gain reimbursement for time spent grappling with administrative issues such as insurance pre-authorizations that eat up valuable resources.
Is it a pipe dream? Perhaps not. Three resolutions coming under the review of the American Academy of Family Physicians (AAFP) seek to shape some form of payment around pre-authorizations, on which practices spend more than 50 hours per week, when factoring in physician time, nursing time and clerical staff time.
The resolutions -- from Montana, Texas and Washington -- will be taken up by the AAFP Congress of Delegates when they meet in Orlando on Sept 18.
"Insurers have no financial incentive to reduce or reverse this cost-shifting to family physicians and their staff," states the resolution from Montana. The resolution seeks "that the [AAFP] encourage the American Medical Association to develop a CPT time-based code for submission for staff time spent in the pre-authorization process."
Pre-authorizations, of course, are notorious sticking points among Medicare Advantage payers. Administrative burdens tied to pre-auth and other duties leads to physician burnout, notes AAFP.
The Texas resolution suggests an alternative payment structure, calling for "each insurer licensed in a state to pay a monthly fee to primary care physicians for each enrolled member to cover the cost of administering the required pre-authorization processes for medical services and pharmaceutical therapies associated with insurance benefit plans."

Editor's note: Ease the burden of pre-auth requirements and other operational challenges related to Medicare Advantage with a training session on Sept. 20, Solving Medicare Advantage challenges: Identify and overcome pain points from pre-auth to denials.
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