Prior authorizations and Medicare

As a member I received the following e-mail from AOPA:A Comme

As a member I received the following e-mail from AOPA:  Comment and query follow.  Please consider this.  Am I missing something?

NERO FIDDLED WHILE ROME BURNED.
 
ARE YOU IN DANGER OF BEING BURNED AND MISSING A PRECIOUS OPPORTUNITY TO
PROTECT YOUR BUSINESS FROM IMMINENT DANGER?  DON’T BE NERO!
 
Medicare (CMS) has issued a proposal that would instantaneously place all prosthetic reimbursements into a prior authorization mode.  If you took advantage of the July 8th free AOPA Webinar you know:
1. Medicare Prior Authorization is not by any means a guarantee that you will be paid.
2. Medicare Prior Authorization would not be a substitute for RAC and other audits-rather, you’d have the new burden of prior auth. + existing misbegotten audits
3. Medicare Prior Authorization is a threat to quality of care for your Medicare patients.
4. Don’t believe that ‘nothing could be worse’ than the current audit-crazed
Medicare system for O&P-the process for prior authorization as
proposed by Medicare would take a horrible situation and make it worse.
Defend your business…work toward a solution…VOICE YOUR POSITION BY TAKING 2 MINUTESTO SEND MEDICARE YOUR COMMENTS.  Click here to send comments to CMS!
 
Enlist your patients in the fight.  A package is being mailed to you (you should be receiving it early next week) that includes 10 postcards you can ask your amputee patients to sign-once signed, just seal the self-mailer and return to AOPA
postage-free, and we’ll deliver your patient’s voice to CMS also!
 
If you want to learn more about this, sign up for the final AOPA FREE webinar on MEDICARE PRIOR AUTHORIZATION, slated for Tuesday afternoon, JULY 22nd at 1 PM, EDT. Click here to sign up for the free webinar.

ABSOLUTE DEADLINE TO RECEIVE COMMENTS IS JULY 28, 2014
 
Speak now or forever hold your peace…
 
DON’T BE NERO!!! 
 
Prior Authorization | AOPA – AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION
 
           
Prior Authorization | AOPA – AMERICAN ORTHOTIC &…
Prior Authorization:  Be A Player in Shaping Your Future AND Be Careful What You Ask For
View on r20.rs6.net Preview by Yahoo
 
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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.

Kevin C. Matthews, CO/LO
Advanced Orthopedic Designs
12315 Judson Rd. #206
San Antonio, Texas  78233
(210) 657-8100
(210) 657-8105  fax