Replies to Medicare Prior Authorization question

Replies to Medicare Prior Authorization question

Kevin Matthews

7/16/2014

I received a few replies to my query:


My query,
Hello all,


I received a few replies to my query:


My query,
>
> As a business owner
for the past 7 years I have done my battles with insurance companies. 
The insurances I have the fewest issues with require prior
authorization.  When I receive an authorization based on the diagnosis
codes and level of service requested (L-Codes) I know they have
considered the claim valid.  That doesn't preclude possible
complications on the claims side but, in my experience, they are fewer
and more easily appealed.  We always get paid!  We battle until we win
because we know it IS a valid claim.
>
>
I do not see a downside to prior authorizations with Medicare, as long
as they don't take more than a week or so.  The initial and most
critical decision of diagnosis versus level of service will, or at least
should, be determined.  We all know the rules.  They can request
additional documents on the claims or preauth side, which we all know we
need to have.  We are ready to submit what they need because we have
it.  You're half crazy to bill or proceed without it.
>
>
If Medicare acts like a professional insurance company and processes
and replies in a timely manner, how is that bad?  I read the e-mail. 
Doom and gloom!!!  Really?
>
> Why is AOPA so vehemently opposed to this???   ???
>
> ***  I will post replies with names attached for credibility, unless you request otherwise.

Replies******************

Kevin, I agree with you. If prior authorization prevents me from buying
 prosthetic components  to build a leg that will be denied for payment
or recouped, I much rather have the denial form the get go and save
myself the expense and heartache. I don't know how this can be a bad
thing. I have not heard any rational argument against it, have you?

Imelda