Imaging gatekeepers: Another thing to slow down doctors

Precertification for imaging tests is a re-emerging trend among health insurers, but it's a requirement physicians say only adds to their administrative hassles.

By Mike Norbut, AMNews staff. July 3, 2006.

For some physicians, getting an imaging test for their patients means navigating an obstacle course. Before scheduling an imaging test, physicians increasingly have to call the patient's insurance company or its designated representative for approval. Insurers are using precertification strategies to address what they consider to be overutilization of high-tech tests, such as MRI, CT, nuclear imaging and PET scans.

Physicians see the trend as yet another clinical roadblock and a financial setback that trims their margins with extra overhead costs and lost productivity. At best, it can take longer to get a test scheduled, and some requests even can be denied.

The health plan strategy could especially affect medical groups that have purchased their own equipment in the interest of building ancillary revenue while offering patient convenience. With precertification requirements in place, physicians no longer can just end an appointment by sending a patient down the hall for a same-day imaging test. Instead, the physician's office must submit the relevant information, usually to a third-party imaging management company, and the patient must return at a later time.

Most preauthorization policies allow for immediate imaging tests in emergency, urgent care or inpatient settings, while focusing on tests conducted in outpatient settings.

"Nurses have many other things they need to do besides sit on the phone, like take care of patients," said Jim Wade, MD, a medical oncologist in Decatur, Ill. "But this is not just taking away from nurses' time. This is affecting patients' lives."