Medicare audits/official checklists for prior authorization
Randy McFarland
Description
Collection
Title:
Medicare audits/official checklists for prior authorization
Creator:
Randy McFarland
Date:
7/10/2013
Text:
Hi Listmemebers,
In the current model of audits and recovery of payments, we are frequently
left holding the bag of time, materials and professional expertise, overhead
and payroll expenses already paid out. They are basically saying we should
have known NOT to provide care BEFORE we provided it.
Why shouldn't this determination be made PRIOR to providing care? We are
having to spend an inordinate amount of time with the details in our
documentation in hopes we won't be burdened with the time requirements to
prove the patient truly deserves the care received. They know they get to
keep their commission on all the denials we couldn't get to before the
deadline.
WHY NOT HAVE CHECK LISTS?
As it is now, all the requirements for each Procedure code and ICD-9
diagnosis are to be incorporated within our progress notes, frequently over
several visits. The auditors are supposedly going through all of the
progress notes to find each item on their requirements list. Shouldn't
there be an actual literal official list that we ALL could be working
from? The providers would check off the requirements on the list (verifying
what's in our notes) when creating our notes and submit the list. In turn,
the auditors would use that same list (that we submitted) when processing
authorization requests.. They would then return that official list to us
specifying exactly where any problem is.
Once this is all clarified and verified, we would then receive the
authorization to proceed knowing we'll be paid for our efforts.
It's my understanding that these changes in policy would have to come down
from Congress.
Any comments of suggestions are welcome, including from the auditors who
read this Listserve!
Randy McFarland, CPO
In the current model of audits and recovery of payments, we are frequently
left holding the bag of time, materials and professional expertise, overhead
and payroll expenses already paid out. They are basically saying we should
have known NOT to provide care BEFORE we provided it.
Why shouldn't this determination be made PRIOR to providing care? We are
having to spend an inordinate amount of time with the details in our
documentation in hopes we won't be burdened with the time requirements to
prove the patient truly deserves the care received. They know they get to
keep their commission on all the denials we couldn't get to before the
deadline.
WHY NOT HAVE CHECK LISTS?
As it is now, all the requirements for each Procedure code and ICD-9
diagnosis are to be incorporated within our progress notes, frequently over
several visits. The auditors are supposedly going through all of the
progress notes to find each item on their requirements list. Shouldn't
there be an actual literal official list that we ALL could be working
from? The providers would check off the requirements on the list (verifying
what's in our notes) when creating our notes and submit the list. In turn,
the auditors would use that same list (that we submitted) when processing
authorization requests.. They would then return that official list to us
specifying exactly where any problem is.
Once this is all clarified and verified, we would then receive the
authorization to proceed knowing we'll be paid for our efforts.
It's my understanding that these changes in policy would have to come down
from Congress.
Any comments of suggestions are welcome, including from the auditors who
read this Listserve!
Randy McFarland, CPO
Citation
Randy McFarland, “Medicare audits/official checklists for prior authorization,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/235384.
