Orthopedic Coding Alert
Find Flexibility in Delegating Prior Authorizations
Question: If a patient’s prescribed medication needs a prior authorization from their insurance, can the pharmacy do that or does it have to be from the prescribing physician’s office? Texas Subscriber Answer: Prior authorizations for medications have to be sought by the physician’s office — but not necessarily by the physician. Melissa Kirshner, MPH, CPC, CPCO, CDEO, CRC, CFPC, CPMA, COBGC, CEMC, CPC-I, executive director at Olympia Medical LLC, says that in her workplace, there are two ambulatory care clinical pharmacists, who spend two days a week in the office, and instead of seeing patients, just spend the work hours on the phone navigating prior authorizations. “If I walk down the hall, usually their door is shut, because on they’re on the phone fighting for patients to get their medications.”
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