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.
Levin
David C
DC
Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. david.levin@jeffersonhospital.org
Bree
Robert L
RL
Rao
Vijay M
VM
Johnson
Jean
J
D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data*; D019982:Organizational Case Studies; D011872:Radiology Department, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000706:statistics & numerical data; D013675:Technology, High-Cost / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000379:methods*