Preapproval of Sinus Computed Tomography for Evaluation of Chronic Rhinosinusitis Does Not Save Healthcare Costs

Abstract

Objectives:

Evaluate cost effectiveness of required pre-approval for computed tomography (CT) of the sinuses for chronic rhinosinusitis (CRS) evaluation by weighing the associated cost of pre-approval against savings from rejected claims. Study design: Retrospective analysis of prospectively collected data. Setting: An academic otolaryngology practice.

Methods:

Over a 6-month period, all sinus CT scans ordered and requiring pre-approval by a third-party payer were tabulated. Characteristics of the pre-approval process that were recorded and analyzed included time spent by office administrative staff, need for peer-to peer review, and time spent by the ordering physician.

Results:

All 111 sinus CT scans ordered required pre-approval based on insurer requirements—38 performed by computer, 71 by telephone, and 2 required both–costing an average of 8.1 minutes per scan by administrative staff (range: 2.0 – 20.0 minutes). 13 pre-approvals required peer-to-peer telephone interaction by the ordering physician, using an average of 7.7 minutes (range 5 – 12 minutes). In no case was the insurance company “peer” an otolaryngologist. Moreover, no sinus CT scan pre-approval was ultimately rejected by the third party payer.

Conclusions:

Pre-approval for sinus CTs ordered by otolaryngologists neither saves costs for third-party payers nor leads to appropriate rejection of scan requests because sinus CT for the evaluation of CRS is well-established and the standard of care. However, pre-approval in this context comes at the expense of practice administrative and physicians’ time. Pre-approval for sinus CT scans ordered by an otolaryngologist for evaluation of CRS is an unnecessary and costly requirement.