The 48 hours that decide an infusion's margin

For a practice that buys its own drugs, the authorisation queue is not a back-office function. It is the mechanism that determines whether inventory becomes revenue or becomes a write-off.

The non-negotiable sequence

Verify coverage → obtain authorisation → acquire drug → administer → bill. Every reordering of those steps moves risk onto the practice's balance sheet. Where clinical urgency requires starting ahead of approval — which it sometimes genuinely does — that should be a named exception, authorised by a defined person, with the financial exposure recorded rather than absorbed silently.

The criteria sheet

One page per drug, per payer. Four fields only: is authorisation required, what clinical criteria must the documentation demonstrate, what is the submission channel, and what is the expected turnaround. Date it, version it, and assign someone to review it quarterly — payer medical policy changes on its own schedule.

The step everyone misses

Initial authorisations cover a defined duration. Antimicrobial courses extend for clinical reasons. If nothing in your workflow triggers a reauthorisation before the approved period expires, therapy continues into a coverage gap and the resulting denial arrives after several weeks of drug has already been administered.

Build the expiry date into the same system that schedules the infusions, with an alert far enough ahead to file. This single control prevents a large share of high-value denials.

The queue

1. One named owner, with a named backup, and enough capacity that the queue is worked daily.
2. A clock starting at referral, not at first submission.
3. A daily review of everything past target, with defined escalation to peer-to-peer.
4. Criteria language embedded in clinical templates for your highest-volume therapies, so documentation satisfies the requirement as a by-product of good notes.

The metric

Track median time from referral to first dose, plus authorisation-related therapy delays per month and the dollar value of denials attributable to authorisation. The first is a clinical quality measure and a financial one at the same time, which is why it is the right number to put in front of the whole team.