State stalls NYC-area prior authorizations

Sunday, January 9, 2005

January 10, 2005

ALBANY, N.Y. -  Since New York’s Department of Health closed its medical review office in New York City Nov. 1, downstate rehab suppliers say prior authorizations for new wheelchairs and repair work have come to a virtual standstill.
“Not a single downstate dealer has gotten anything approved,” said Laurie Hyams at Total Health Care Industries in New Hyde Park. “It’s all coming back voided, or pended or denied.”
Other suppliers said that by Jan. 7 they’d heard of just two prior authorizations processed since the state transferred all of the NYC medical review work to the Albany office.
The downstate office annually processed about 17,000 prior authorizations for DMEPOS, according to one New York supplier. In September, the Department of Health asked suppliers for suggestions on how to manage the transition. But the suggestions seem to have fallen on deaf ears.
“We knew we were in for a change, but we didn’t realize it would be to this magnitude,” said one supplier.
Suppliers say the Albany office is looking for a level of detail for work that simply should not require as much. For example, the DOH now expects a PT/OT evaluation for certain repair work.
“Let’s say someone’s got a broken power wheelchair?” said one supplier. “What’s an OT/PT going to do after we do our evaluation -  back it up or affirm that what we said is wrong is wrong.”
Getting OT/PTs to evaluate work is problematic simply because there are too few available, say suppliers, and because the work isn’t remunerative.
Suppliers voiced their concerns at a recent meeting, but Hyams said the meeting didn’t resolve their complaints.
“They simply reviewed the manual,” she said. “It was basically going over how it’s going to be.”
An official at the DOH medical review office declined to be interviewed for this story.