Volume 7, Issue 1 , Pages 33-38, January 2010
A Prior Authorization Program of a Radiology Benefits Management Company and How It Has Affected Utilization of Advanced Diagnostic Imaging
Radiology benefits management companies have evolved in recent years to meet the need to control the rapid growth in advanced diagnostic imaging. The Obama administration and other key policymakers have proposed using them as a cost-control mechanism, but little is known about how they operate or what results they have produced. The main tool they use is prior authorization. The authors describe the inner workings of the call center of one radiology benefits management company and how its prior authorization program seems to have slowed the growth in the utilization of MRI, CT, and PET in the large markets of one commercial payer.
Key Words: Medical economics, preauthorization, prior authorization, radiology benefits managers, radiology and radiologists, socioeconomic issues
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Disclosure: Drs Levin and Bree are consultants to HealthHelp. Ms Johnson is director of health care data analysis at HealthHelp. Dr Rao is a professor and chair of the Department of Radiology at Thomas Jefferson University, which has a contract with HealthHelp to provide peer-to-peer telephone consultations with ordering physicians.
PII: S1546-1440(09)00462-1
doi:10.1016/j.jacr.2009.09.012
© 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Refers to erratum:
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Volume 7, Issue 1 , Pages 33-38, January 2010
