Tag: Prior Authorization
AMA works to right-size prior auths
November 12, 2024HME News Staff
ORLANDO, Fla. – The American Medical Association will consider legislative and legal actions to fight retrospective denial of payment for care that has been pre-certified by an insurer.
A 700-member House of Delegates has approved a new policy that directs the AMA to support a federal prohibition on the inappropriate denial of payment for medically necessary care that has been pre-certified by insurers and encourages the association to take legal action against insurers that engage...
Pacific Therapy Access rebrands, adds DME division
August 13, 2024HME News Staff
DALLAS – Pacific Therapy Access, a provider of reimbursement strategies, prior authorization and health insurance appeals services, has rebranded to Walnut Hill Medical and added DME, health economics and market access divisions. "We are thrilled to embark on this new chapter as Walnut Hill Medical," said Chris Hanna, CEO of Walnut Hill Medical. "This transformation represents our ongoing commitment to excellence and innovation in health care solutions. Our expanded services...
CMS adjusts requirements for replacements
July 18, 2024HME News Staff
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...
Industry keeps heat on Medicare Advantage
July 3, 2024Theresa Flaherty, Managing Editor
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...
State update: Carelon transition delayed
July 1, 2024HME News Staff
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...
Parachute Health embeds authorization process
June 18, 2024HME News Staff
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...
Lawmakers reintroduce prior auth bill
June 13, 2024HME News Staff
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,”...
AMA seeks greater oversight of MA plans
June 11, 2024HME News Staff
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...
CMS piles on prior auth requirements
February 7, 2024Liz Beaulieu, Editor
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...
In brief: Prior auth burden, VGM Forbin president, JANZ acquisition
January 19, 2024HME News Staff
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...