Two Things to Know About ePA in Radiation Oncology

Posted by Robert Lynch on Apr 25, 2020 2:05:00 PM
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We have consensus!  Prior Authorizations need to improve and improve quickly.  So says a collaboration of the AHA, AHIP, AMA, APhA, BCBSA, and MGMA who have announced a Consensus Statement outlining their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

Prior authorizations are growing and can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive. Streamlining approval processes will enhance patient access to timely, appropriate care and minimize potential disruptions.  However, we believe that electronic prior authorizations (ePA) will be a long way off for radiation oncology.

First, utilization management companies consider the best practice of automation to involve the use of decision-support technology that integrates with an electronic medical record (EMR) system to give physicians direct visibility of evidence-based treatment options at the point of care.  Since these systems have not been implemented with any scale in core EMR systems, we believe it will be a long time before work even begins on ancillary EMR’s specific to radiation oncology.

Second, utilization management companies will focus on automating the opportunities that have the highest combination of transaction volume and dollar volume.  ePAs have not been fully adopted even in medications which use the National Council for Prescription Drug Programs (NCPDP) transaction standards.  The standard that would be applied for a radiation oncology transaction would be the ePA transaction x12 278 which has only a fraction of the deployment of the NCPDP standards.  For comparison, we developed the following chart comparing radiation oncology transactions and dollar volume to prescriptions. 

So prescription drugs have over 4,000 times the transaction volume, over 70 times the cost, and a more widely adopted standard, yet ePAs are still not fully adopted.

In the meantime, there are things you can do to help streamline your radiation oncology prior authorizations.  Watch our blog for future updates as we share information on how to minimize the time and expense of your PA process.

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1: ASTRO Estimate

2: Est. Courses of treatment x $5,000


Topics: Prior Authorization

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