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Tag: over-utilized codes


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Stakeholders say prior auths need to be timely, efficient

May 30, 2014Theresa Flaherty, Managing Editor

WASHINGTON - Although industry stakeholders are still combing through a plan to implement a prior authorization (PA) process for certain DME, they think it could be a good thing—with a few caveats.PAs can provide assurance that the criteria for medical necessity have been met and that the claim will likely stand up under an audits. Both mean the provider is more likely to get paid.“I think folks generally support it, but it's got to be done on a timely basis and it's got to be efficient,”...

over-utilized codes, prior authorizations, proposal


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