Month: March 2023

Cancer copayment assistance programs can be complex to manage, with various rules and regulations that must be followed. Cancer Center Executives must ensure that these programs are run efficiently and effectively in order to help patients afford their treatment and ensure that your revenue is maximized. In this blog post, we’ll explore the challenges of managing cancer copay programs and offer some tips on how to overcome them. Read on to learn more!

The first challenge of managing cancer copay programs is making sure that all of the necessary funds are available to patients. Many patients cannot afford their treatments and need assistance in order to make them financially possible. To ensure that these funds are available, Cancer Center staff must be organized and proactive when it comes to tracking eligibility, submitting necessary documentation, following program rules, and getting appropriate signatures.

Another challenge of managing cancer copay programs is staying up-to-date with the ever-changing regulations. Since laws and regulations are continuously being updated or changed, hospitals must remain aware of any changes in order to ensure that they are compliant with local and federal guidelines. Staying on top of these guidelines can be time-consuming, but it is essential for running a successful program. One of the biggest examples here is ensuring that your federally insured patients realize that they are unfortunately restricted from these programs and therefore not able to benefit the same way as commercially insured patients.

Finally, managing cancer copay programs involves a lot of paperwork and data entry. Hospitals must keep detailed records of application status, bills that have been submitted, checks that have been received and copay cards that have been loaded in order to ensure accuracy and compliance. This can be tedious work, but it is necessary for running an efficient program.

Fortunately, there are some tips that Cancer Center Executives can use to make managing cancer copay programs easier. First, hospitals should partner with an outside organization that can help them manage their program more effectively. These organizations have the experience and expertise needed to ensure that everything is done correctly and in compliance with regulations. Organizations like Qualify Health provide a fully managed service that combines a human layer of service and intelligence to streamline the process of collecting and entering data. They then continue to ensure that all bills are submitted on behalf of the patient and the funds are sent to the hospital.

The key to successfully managing cancer copay programs is staying organized and proactive in ensuring all patients are signed up and accessing the care they need. With the right tools and strategies, hospitals can ensure that their programs are running smoothly and helping as many patients as possible.

Remember, managing cancer copay programs doesn’t have to be a struggle. By utilizing the right resources and staying organized, Cancer Center Executives can ensure that their program is efficient and compliant with all regulations. If you need help managing your program, contact us today for more information. We’re here to help!

Prior authorizations are essential to make sure that a patient’s insurance carrier is going to pay for their treatment. The greatest doctor with the best diagnosis and treatment protocol is ineffective if the patient cannot afford it or if their insurance will not cover it due to a lack of authorization. What causes prior authorizations to be denied, slip through the cracks, or otherwise be left unfulfilled? Here is a case regarding a real patient with their hepatitis C medication.

Patient X had been confirmed to have Hepatitis C and the drug ordered by the prescriber required a prior authorization. The doctor who made the diagnosis recommended a protocol involving Epclusa which, through most insurance carriers, can demand quite a few clinical notes to support the administration of the medication: a check for cirrhosis, a concurrent infection of HBV (hepatitis B), whether or not the patient has tried and failed a similar medication before—just to name a few!

The pharmacy that was to dispense the medication noticed that the drug did require prior authorization (most prior authorizations for outpatient prescriptions start in the pharmacy!) A request was sent to the office and an initial authorization request was sent to the insurer. However, a follow-up fax was sent back with the requesting of additional clinical information – a scan that wasn’t performed yet on the patient’s liver. The staff made an appointment for the patient to come in and the scan was performed. Afterwards, though, the scan was never sent to the insurer and, thusly, the authorization was denied. A follow-up authorization was initiated and, as what happens after most denials, it was immediately denied as the initial authorization was and now an appeal is required.

An appeal is when the office staff, patient, or advocate of the patient claims that the decision to deny was in error and to have the determination overturned. This was strange to the staff because all the criteria matched, they were just trying to send the required information that was asked of them. Part of the prior authorization process is to follow the flow: even though the office staff did everything within their power to advocate for the patient, the idea of an appeal for a medication that fit the indication did not quite make sense, it should be approved!

After three months of back and forth with the insurer, Qualify Health was requested for assistance, able to intervene, find out the proper format for an appeal, accrue and compile the necessary clinical information to support the use of the drug, have a signed attestation from the prescriber that the information provided is verified, and submitted through the proper channels with an URGENT expedite for a faster turn-around! After Qualify’s assistance, the drug was approved for the patient within twenty-four hours with a gracious and appreciative patient that was finally going to get the treatment that they needed.

Ultimately, prior authorizations are, and should be, part of the clinical processes in any office. There should always be a flow, a delegate for duty, and organization for the myriad processes that every insurance carrier requires based on the drug, treatment protocol, or inpatient administration because anything beyond immediately is too long for a patient that requires treatment.