Tag: Prior Authorization

WASHINGTON – CMS will require prior authorization for all power mobility devices being replaced within the five-year useful lifetime effective June 2, NCART reports. Providers should submit prior authorizations as an expedited request and the agency will process them within two business days. For wheelchairs being replaced due to loss, theft or irreparable damage, the following should be included with the request: information and/or detailed reports that explain the reason leading to the need...

YARMOUTH, Maine – There’s a lot of noise right now around improving the prior authorization process for Medicare Advantage plans and the HME industry needs to make sure it continues to add its voice to the conversation, say stakeholders.  Most recently, in June, members of the House of Representatives and the Senate reintroduced bipartisan legislation to streamline and standardize the use of prior authorization for these plans. The Improving Seniors’ Timely Access to Care...

WASHINGTON – Carelon Medical Benefits Management will not review Medicaid prior authorization requests for DMEPOS in Maryland (Wellpoint), Missouri (Healthy Blue) and Wisconsin (Anthem) on July 1 as planned, AAHomecare reports. The transition has been postponed until further notice, according to the association. “Suppliers in Maryland, Missouri and Wisconsin should continue to follow the current process when requesting authorizations for DMEPOS services under Medicaid,” AAHomecare...

NEW YORK – Parachute Health has launched a partnership with Optum and Walgreens/CareCentrix to embed prior authorization workflows directly into the prescribing process, liberating providers from what’s typically a back-and-forth process. “I am excited to be streamlining the ordering and authorization process by partnering with payers and building the necessary cost-controls to eliminate the current administrative burden that all stakeholders face," said David Gelbard, CEO...

CHICAGO – Members of the House of Representatives and Senate have reintroduced bipartisan legislation to streamline and standardize the use of prior authorization within Medicare Advantage. The Improving Seniors’ Timely Access to Care Act, which has the support of the American Medical Association, features targeted policy changes to reduce the scored cost of the legislation, an obstacle last Congress. “We thank the sponsors for writing the bill so it will attract even more support,”...

CHICAGO – Physician and medical student leaders at the Annual Meeting of the American Medical Association (AMA) House of Delegates approved policies to address the need for greater oversight of health insurers’ use of prior authorization controls on patient access to care. The new policies address insurer accountability and transparency for PA denials. “Waiting on a health plan to authorize necessary medical treatment is too often a hazard to patient health,” said AMA...

YARMOUTH, Maine – A rule finalized in January is CMS’s latest bid to fine-tune the prior authorization process for Medicare Advantage plans and other payers to increase efficiency and transparency.  The agency in January finalized a rule requiring MA plans and other payers like Medicaid and Medicaid managed care to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. For some payers, CMS says, this cuts the current...

WASHINGTON – CMS has finalized a rule that sets requirements for Medicare Advantage organizations and other programs to improve the electronic exchange of health information and prior authorization processes and reduce burden on patients, providers and payers.  The agency estimates its Interoperability and Prior Authorization Final Rule (CMS-0057-F) will result in $15 billion in estimated savings over 10 years.  “When a doctor says a patient needs a procedure, it is essential...

WASHINGTON – CMS has finalized a rule that sets requirements for Medicare Advantage organizations and other programs to improve the electronic exchange of health information and prior authorization processes and reduce burden on patients, providers and payers.  The agency estimates its Interoperability and Prior Authorization Final Rule (CMS-0057-F) will result in $15 billion in estimated savings over 10 years.  “When a doctor says a patient needs a procedure, it is essential...

YARMOUTH, Maine – Prior authorizations have their uses, but they also create a heavy burden with no guarantee of payment, say 58% of respondents to a recent HME Newspoll.  “Prior authorization is fine if the insurance plan honors their end of the agreement,” wrote one respondent. “To do all the work to obtain the PA only to receive a denial is very frustrating. Even more frustrating is to have the plan tell you that prior authorization is not a guarantee of payment.”  Prior...