More replies to Medicare Pre-Auth
Kevin Matthews
Description
Collection
Title:
More replies to Medicare Pre-Auth
Creator:
Kevin Matthews
Date:
7/17/2014
Text:
Hello All,
I understand AOPA's position a little more, I think.
Hello All,
I understand AOPA's position a little more, I think. The new issue of The O&P Almanac discusses this topic more in-depth. July 2014 Almanac
July 2014 Almanac
American Orthotic & Prosthetic Association (AOPA) - July 2014 Issue - O&P Almanac
View on issuu.com Preview by Yahoo
They would like a guarantee of payment without audit if prior authorization is obtained. All my insurance contracts have the stipulation that prior authorization (PA) is not a guarantee of payment. I think this will be an impossible hurdle, but it would be nice.
If pre-auths go the way of ALJ hearings then they may end up taking months to get, then Medicare may say they are not taking any new prior authorization requests due to backlog. One thing I do know is that I hate the feeling in the back of my mind that Medicare could end up auditing all my patients for the past 3 years and decide I owe them $723,947.46. Can you pay with cash or CC? Maybe PAs are not the answer, but I would vote to give them a try. We should attempt make sure they do it in the best way possible and look out for our interests. This system didn't work out to well for power wheelchairs, but they've always been troublesome for some reason.
More Replies:
Kevin,
I don't think AOPA is opposed to prior auth. I think they just want to
make it the best it can be, if it is going to happen. I think the
changes they propose would make it a very good system. As is, it would
be better than what we have currently. The current medicare proposal
could be better. I think that AOPA sees that medicare will do whatever they want in the end, as they have done all
along, but if we can influence it to be better, that is better. I think medicare knows that they can do whatever they want, but if they make
some changes to their plan that we, or AOPA are presenting, later there
will be less chance of complaints from us, or AOPA, because they can
point to it and say, this is what you proposed. In our state, we did
similar, knowing insurance lobby wouldn't go for some things in parity
legislation, and then settled on what we were happy to accept anyhow.
Basically, shoot for that stars, and maybe we will at least end up in
orbit, rather than sitting on the ground where we currently are.
I think you could agree that you would like to see the auth as favorable
to our patients and us as possible. I think that is reasonable and what AOPA is hoping for.
I don't think AOPA has the power to have prior auth killed, and they know it. At least if we can get it improved, it will be better.
I think your actions may hinder the end goal of improved prior auth, as
AOPA's suggestions would do. Basically, you are saying, whatever
medicare does to us is fine, just take their lowest offer and be happy.
Why not push back and try to improve it on the front end, while it may
be possible?
Please don't include my name, it's not worth the headache.
I understand AOPA's position a little more, I think.
Hello All,
I understand AOPA's position a little more, I think. The new issue of The O&P Almanac discusses this topic more in-depth. July 2014 Almanac
July 2014 Almanac
American Orthotic & Prosthetic Association (AOPA) - July 2014 Issue - O&P Almanac
View on issuu.com Preview by Yahoo
They would like a guarantee of payment without audit if prior authorization is obtained. All my insurance contracts have the stipulation that prior authorization (PA) is not a guarantee of payment. I think this will be an impossible hurdle, but it would be nice.
If pre-auths go the way of ALJ hearings then they may end up taking months to get, then Medicare may say they are not taking any new prior authorization requests due to backlog. One thing I do know is that I hate the feeling in the back of my mind that Medicare could end up auditing all my patients for the past 3 years and decide I owe them $723,947.46. Can you pay with cash or CC? Maybe PAs are not the answer, but I would vote to give them a try. We should attempt make sure they do it in the best way possible and look out for our interests. This system didn't work out to well for power wheelchairs, but they've always been troublesome for some reason.
More Replies:
Kevin,
I don't think AOPA is opposed to prior auth. I think they just want to
make it the best it can be, if it is going to happen. I think the
changes they propose would make it a very good system. As is, it would
be better than what we have currently. The current medicare proposal
could be better. I think that AOPA sees that medicare will do whatever they want in the end, as they have done all
along, but if we can influence it to be better, that is better. I think medicare knows that they can do whatever they want, but if they make
some changes to their plan that we, or AOPA are presenting, later there
will be less chance of complaints from us, or AOPA, because they can
point to it and say, this is what you proposed. In our state, we did
similar, knowing insurance lobby wouldn't go for some things in parity
legislation, and then settled on what we were happy to accept anyhow.
Basically, shoot for that stars, and maybe we will at least end up in
orbit, rather than sitting on the ground where we currently are.
I think you could agree that you would like to see the auth as favorable
to our patients and us as possible. I think that is reasonable and what AOPA is hoping for.
I don't think AOPA has the power to have prior auth killed, and they know it. At least if we can get it improved, it will be better.
I think your actions may hinder the end goal of improved prior auth, as
AOPA's suggestions would do. Basically, you are saying, whatever
medicare does to us is fine, just take their lowest offer and be happy.
Why not push back and try to improve it on the front end, while it may
be possible?
Please don't include my name, it's not worth the headache.
Citation
Kevin Matthews, “More replies to Medicare Pre-Auth,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/236544.
