Simplifying the Prior Authorization Process
Faculty: Joseph Feuerstein, MD and Laurie Powers Yopp, RN

CME Accreditation for this article expired on February 27, 2019

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Simplifying the Prior Authorization Process to Improve IBD Patients' Access to Biologics

  • CME: 1.0 AMA PRA Category 1 Credit(s)TM
  • CNE: 1.0 Contact hour

Release Date: February 27, 2018
Expiration Date: February 27, 2019

Program Description:

This CME and CE certified activity will provide learners with practical strategies to reduce time spent on prior authorizations (PAs) and increase success rates to ensure appropriate patients receive preferred therapies in a timely manner. Emphasis will be placed on minimizing access barriers to biologic therapy in patients with IBD. The webinar will conclude with case studies.

Estimated time to complete this activity is one hour.

Hardware And Software Requirements:

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Target Audience:

This activity is intended for registered nurses, nurse practitioners and physician assistants engaged in the care of patients with Inflammatory Bowel Disease (IBD).

Educational Objectives

After completing this activity, the participant should be better able to:

  • Describe real-world ways to reduce time spent on prior authorizations for biologic therapies used for patients with moderate to severe IBD.
  • Explain how to establish a protocol to consistently document data required for prior authorizations and communicate it more effectively to payers.
  • List the different ways practices can use to complete PAs, as well as the pros and cons of methods including NCPDP ePA transactions, payer portals and secure emails.
  • List tools and resources that can improve provider/payer relationships and simplify the prior authorization and appeals process for GI practices.
  • Identify situations where a biologic drug should be considered early and discuss supporting evidence for appeals letters.

Faculty

Joseph Feuerstein, MD

  • Attending in Gastroenterology
  • Center for Inflammatory Bowel Disease
  • Beth Israel Deaconess Medical Center
  • Assistant Professor of Medicine, Harvard Medical School.

Laurie Powers Yopp, RN

  • IBD Nurse Coordinator
  • Division of Gastroenterology and Hepatology
  • UNC Multidisciplinary IBD Center.

This activity is supported by an independent educational grant from Takeda Pharmaceuticals U.S.A., Inc.

DETAILS

Accreditation Information

JOINT ACCREDITATION STATEMENT

In support of improving patient care, Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

PHYSICIAN CONTINUING MEDICAL EDUCATION

The Postgraduate Institute for Medicine designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CONTINUING NURSING EDUCATION

The maximum number of hours awarded for this Continuing Nursing Education activity is 1 contact hour

NURSE PRACTITIONER AND PHYSICIAN ASSISTANT CREDIT RECIPROCITY:

American Association of Nurse Practitioners (AANP) National Certification Program accepts AMA PRA Category 1 CreditTM from organizations accredited by the ACCME.

American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 CreditTM from organizations accredited by the ACCME. Physician Assistants may receive a maximum of 1.0 credit of Category 1 for completing this program.

ANY QUERIES?

For any questions relating to certification for this activity, please contact Postgraduate Institute for Medicine at: inquiries@pimed.com or (303) 799-1930.

Program Agenda

PROGRAM AGENDA

  • IBD and Biologics Review and Definitions (2 minutes)
  • Prior Authorization Terms and Overview (4 minutes)
    • Effect on Patients and Administrative Burden
  • AMA Recommendations to Reduce Time/Cost Burdens of Prior Authorizations (12 minutes)
  • Currently Available Methods for Completing Prior Authorizations (8 minutes)
    • ePA (pros, cons, examples and future for Biologics Medications)
  • Writing Successful Appeal Letters When Faced with Denials (7 minutes)
  • Patient Support Programs and Key Financial Resources for IBD Patients (2 minutes)
  • How Other GI Practices Deal with PAs and How to Improve (20 minutes)
    • 3 GI Practice Case Studies and HCP Roles
    • Proactive Approach to Common PA Questions For Most IBD Patients
      • Specific IBD Patient History including Drugs, Dates, Tests and Other Data Practices Should Record for Every IBD Patient
    • Situations Where a Biologic Should be Considered Early
      • Supporting Evidence for Appeals Letters
    • Specialty Pharmacies
    • Improvement Plan and Model
    • Standardize and Simplify
  • Questions and Answers (5 minutes)
  • Summary and Post-Test

How to Receive Credit

A statement of credit will be issued upon successfully completing the post-test with a score of 75% or better and the activity evaluation. The post-test is located on www.cmeuniversity.com.

During the period February 27, 2018 through February 27, 2019, participants must
1) read the learning objectives and faculty disclosures;
2) study the educational activity; and
3) complete the post-test and the evaluation form.

To answer the questions, click on your selected choice for each answer then proceed to the next question. We recommend that you print a copy of your answers before you submit them to us. Once completed, click on Submit Post-test at the bottom of the page. Your post-test will automatically be graded.

If you successfully complete the post-test (score of 75% or higher), your certificate will be made available immediately. Click on View Certificate and print the certificate for your records. If you receive a score of 74% or less, you will receive a message notifying you that you did not pass the post-test. You may retake the post-test until successful.

There is no fee for this educational activity.

Disclosures

DISCLOSURE OF CONFLICTS OF INTEREST

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

FACULTY

Joseph Feuerstein, MD has nothing to disclose.
Laurie Powers Yopp, RN - Consulting fees from Merck and Speaker's Bureau fees from Takeda

PLANNERS AND MANAGERS

The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose. The MedInsights planners and managers, Kristen Holstead and Laurette Ullian, have nothing to disclose.

DISCLOSURE OF UNLABELED USE

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Media: Internet