A prior authorization program of a radiology benefits management company and how it has affected utilization of advanced diagnostic imaging.
other · Level V
Where this comes from
- Record sourced from PubMed, PMID 20129269.
- Also identified by DOI 10.1016/j.jacr.2009.09.012.
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Abstract
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.
Medical subject headings
- Diagnostic Imaging
- Radiology Department, Hospital
- Reimbursement Mechanisms
- Technology, High-Cost
- Utilization Review