Best Practice Approaches to Prior Authorization for Your Patients with IBD: A Three-Part Series for Improving Processes and Success Rates

Best Practice Approaches to Prior Authorization for Your Patients with IBD: A Three-Part Series for Improving Processes and Success Rates
CME Outfitters LLC

 
 
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CMEO Multimedia Snack

Premiere Date: Monday, April 30, 2018

This activity offers CE credit for:

  1. Physicians (CME)
  2. Nurses (CNE)
  3. Pharmacists (ACPE)
  4. Other

All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™

Credit Expiration Date: Tuesday, April 30, 2019

Begin Activity Now

Faculty

 

Francis A. Farraye, MD, MSc Francis A. Farraye, MD, MSc
Clinical Director, Section of Gastroenterology
Director, Inflammatory Bowel Disease Center
Boston Medical Center
Professor of Medicine
Boston University School of Medicine
Boston, MA

 

Michele A. Rubin, APN, CNS, CGRN Michele A. Rubin, APN, CNS, CGRN 
Associate Director, Inflammatory Bowel Disease Center
Director, Advanced Practice Nursing
University of Chicago Medicine
Chicago, IL

 

Toni M. Zahorian, PharmD, BCACP Toni M. Zahorian, PharmD, BCACP
Clinical Pharmacy Specialist – Ambulatory Care
Center for Digestive Disorders
Boston Medical Center
Boston, MA

 

Statement of Need

This activity is a combined version of the three-part snack series on prior authorization.

Much of the national healthcare debate is centered around gaining insurance coverage for more Americans, but individuals with chronic diseases know their issue is not always about having coverage – it is gaining access to treatment within their insurance coverage. Prior authorization (PA) interactions with health insurance companies can be frustrating, taking a heavy toll on clinical workflow, staff time, and patient care. Inefficient PA processes put patients with IBD at risk for poor outcomes from denied access to needed care. Having a plan with proven strategies and resources—for first time submissions and appeal, will ultimately improve outcomes and satisfaction in patients with IBD.

In this three-part series, faculty will share their best practice approaches for improving PA success rates, including important clinical information that should be routinely gathered and documented in the patient’s EHR to minimize barriers to biologic approval. And when denials happen, they will provide strategies for creating a structured appeal that advocates for the best treatment choice for the patient. Following the successful completion of the series, in addition to credit, CME Outfitters will award a Certificate of Excellence in Prior Authorization.

Have questions for our faculty? Use the comment box below the presentation. The faculty will be checking in to respond to learners!

Learning Objectives

At the end of this CE activity, participants should be able to:

  • Evaluate prior authorization (PA) methods that best fit clinical workflow to reduce disruption, establish clear communication with the payer, and minimize delays.
  • Implement a PA protocol to improve documentation in the EHR and minimize barriers to medication approval.
  • Develop a process for an organized and clinically supported appeal for PAs that are inappropriately declined.

The following learning objectives pertain only to those requesting CNE or CPE credit:

  • Evaluate prior authorization (PA) methods that best fit clinical workflow to reduce disruption, establish clear communication with the payer, and minimize delays.
  • Describe a PA protocol to improve documentation in the EHR and minimize barriers to medication approval.
  • Describe a process for an organized and clinically supported appeal for PAs that are inappropriately declined.

Financial Support

Supported by an educational grant from Takeda Pharmaceuticals USA, Inc.

Target Audience

Gastroenterology nurses and other healthcare professionals responsible for the PA process.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CME Outfitters, LLC, designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CNE Credit (Nurses):
Provider approved by the California Board of Registered Nursing, Provider Number CEP 15510, for 1 contact hours

CPE Credit (Pharmacists):
ACPECME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1 contact hours (0.10 CEUs) Universal Activity Number: 0376-0000-18-016-H01-P Type: knowledge-based practice-based

Post-tests, credit request forms, and activity evaluation must be completed online at www.cmeoutfitters.com/TST27387 (requires free account activation), and participants can print their certificate or statement of credit immediately (75% pass rate required). this website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit www.neurosciencecme.com/technical.asp.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, sue of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentation.

Dr. Farraye reports that he is a consultant for Braintree Laboratories Inc.; Celgene Corporation; Ferring Pharmaceuticals; Janssen Pharmaceuticals, Inc.; Merck & Co., Inc; Pfizer Inc.; Protagonist Therapeutics Inc. (DSMB); Takeda Pharmaceuticals U.S.A., Inc. He is a stock shareholder (directly purchased) of Innovation Pharmaceuticals Inc.

Dr. Rubin reports that she is on the advisory board for Pfizer Inc as spokesperson for results of patient and GI survey only.

Dr. Zahorian has no disclosures to report.

Tony Graham, MD (peer reviewer) has no disclosures to report.

Michelle H. Lavigne, PA-C (peer reviewer) has no disclosures to report.

Mae Ochoa, Rph (peer reviewer) has no disclosures to report.

Jan Perez (planning committee) has no disclosures to report.

Sharon Tordoff (planning committee) has no disclosures to report.

Disclosures were obtained from the CME Outfitters, LLC staff. No disclosures to report.

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Questions about this activity? Call us at 877.CME.PROS(877.263.7767).

This document was last modified on: 08/01/2018 09:39:25

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