Welcome to today’s webinar, “Struggling to Process: What Providers Wish They Knew.” Our Speakers are Dr. Raffi Tachdijan, M.D., MPH, FAAAAI, FACAAI, Dr. John Awad, MD, BCMAS, and Elizabeth Johnson, LPN, PACS, CPC. Moderated by Dr. Amanda DeMarzo, PharmD, MBA, PACS.
We discuss the life cycle of the prescription as we have different stakeholders present. Our goal is to understand the different players’ roles in the process.
Typically, the lifecycle of a prescription starts at the appointment with the physician. Based on the patient’s presentation, the physician can work with the patient to determine next steps in achieving better health with shared-decision making. The next steps are not as clear as they once were as more stakeholders got involved, namely health plans, pharmacy benefit managers, and medical benefit managers. Having good support systems set up can lead to better success and approvability of claims.
Most of you are familiar with the NBPAS through our work in building the only accredited certification for prior authorization specialists, the PACS program (https://www.priorauthtraining.org/). The National Board of Prior Authorization Specialists is an affiliate of ACMA. We are a global organization focused on establishing benchmarks of excellence in training for the life sciences and healthcare industries. We aim to set the standard of excellence through certification of professionals as Prior Authorization Certified Specialists.
From that work, we also noticed a need for annual training on compliance standards for healthcare professionals and life science professionals alike. Our annual Healthcare Compliance Attestation ensures teams of professionals are compliant and competent in maintaining the standards set out by federal law and ethics organizations
– Dr. Raffi Tachdijan, Assistant Clinical Professor of Medicine and Pediatrics with UCLA School of Medicine and Chief of Allergy and Immunology with Providence St. John Medical Center.
He will be representing providers as he is an expert allergist with holistic and caring approach to patient care. He specializes in immunotherapy, eczema, trigger point injections, hereditary angioedema, chronic sinus pain and severe asthma.
– Dr. John Awad, Medical Science Liaison with Mallinckrodt Pharmaceuticals.
He will be representing the pharmaceutical industry as an experienced medical and clinical affairs professional. Dr. Awad has a demonstrated history of working in the biotechnology and pharma industry with a dedication to medical affairs as seen by being a Board Certified Medical Affairs Specialist.
– Elizabeth Johnson, Lead Biologics Coordinator with Allergy Partners.
She is representing the authorization specialists as she is the lead biologics coordinator in the largest single-specialty group in the United States. She is also the CEO and Principal Consultant at 5-0-15 Consulting. Elizabeth is a Licensed Practical Nurse (LPN) with a rich background in patient care and holds the Certified Professional Coder (CPC) certification. She is also a Prior Authorization Certified Specialist (PACS), exemplifying her knowledge of some of the most integral parts of the revenue cycle.
In this discussion we discuss how authorizations are increasing and putting a burden on the health system, how pharmaceutical manufacturers and Healthcare Providers can collaborate, Buy and Bill process and workflow, and the Peer to Peer process. Questions tackled today include:
What is the role of a Specialty Coordinator?
What role does a Medical Science Liaison have in relation to healthcare providers and supporting staff?
How does a provider choose a treatment option?
How long does it take to get a prior authorization approved?
How often does a provider run into red tape with payers?
Does a provider often change the course of therapy due to payer claim denials?
What resources does a Medical Science Liaison bring to physicians and providers?
How does Buy and Bill work?
What is the workflow around Buy and Bill?
What are the challenges of Buy and Bill?
Why is labeling and identification of products important for Buy and Bill?
What do you do when your claim or prior authorization is denied?
Are there other people with the manufacturer who can help the approval process?
What are the benefits of Peer to Peer?
What are the challenges of Peer to Peer?
What are the tips on how to request peer to peer?
Do the professionals on the call prefer technology and automation software, similar to CoverMyMeds?