Friday, May 20, 2022

Replies–Using Video for Auths

Kevin Matthews

I had quite a few replies to my post.  Replies follow original post.  Thanks Paul!
Original post:
Hello all.  I had a thought this evening about how sometimes it’s difficult
to get authorizations.  I am thinking about videotaping a minute or two on
each patient.  After I evaluate and obtain a history and we discuss the plan
I would turn the videotape on and show a brief synopsis, demonstrating the
patient’s condition.  If they had a stroke, for instance, you might briefly
video gait, and your passive and active muscle testing.  Then you would
discuss deficiencies, the plan, and the expected outcome.  It could be done
in under two minutes of video.
Mine is mainly a pediatric practice and I see a lot of Texas Medicaid
patients.  They recently changed their guidelines and you have to jump
through a lot of hoops to get auths now.  Not necessarily a bad thing.  I
thought I might send a note with the auth request explaining I have a video
evaluation of the patient available.  All they would need to do is send an
e-mail request.  I would also include parent comments in the video.  I would
reply with the link to that patient’s internet webpage on my website.  In my
website deal I have unlimited webpages.  I can protect the link and will
also have signed releases explaining possible breach.     

I am curious as to your thoughts.  I could elaborate further about possible
other benefits, like if you had a video library you could watch before each
following visit…
Have any of you tried this?  Does it sound feasible.  I would appreciate
thoughts and will post replies, if any.  Thanks Paul!

Kevin C. Matthews, CO/LO
Certified/Licensed Orthotist
Advanced Orthopedic Designs
12315 Judson Rd. Suite 206
San Antonio, TX 78233
Phone: 210-657-8100
Fax: 210-657-8105

Hi Kevin

Video assessment is very valuable, especially pre and post treatment. I use an inexpensive but very valuable tool. Which
helps when proving the benefit of used the suggested orthosis or prosthesis..
Hope this helps/

Hi Kevin.
I once did a video  to get a C-leg for a patient and it seemed to help matters. Now I make  photos of all patients’ residual limbs and prostheses whenever I  see a problem or do a casting.
Sounds like a great idea.
I am obviously not as computer literate as yourself, but would really like to look into it for our clinic. 
A few questions:
How exactly would you protect the link?
Would you be able to provide a copy of the release that the patient would sign?  I am in Canada, and would likely need the lawyers to give it the okay before proceeding.
We see many WCB, peds and Native persons.  The paperwork is getting worse and worse.  A picture (or video) certainly would help in many cases.

Hi Kevin,
Although I found your idea to have merit I figured I would throw in a negative spin for discussion purposes.
In a perfect and trusting world I believe your idea would have appeal to many. Unfortunately, no effort to obtain necessary authorizations, including the one you are suggesting can be 100% safe from those who would be intent on committing fraud. Imagine that some dirt bags would go so far as to find actors to portray patients, faking physiological conditions that would warrant orthotic intervention.
In order to make your proposal feasible the system will still need to rely on the honesty and character of the person or persons who are the gait keepers and in most cases that still is the managing physician. If we could get all third party payers to finally agree on who should be considered “qualified” to provide custom made or custom fit orthotics we could possibly move forward. The likely hood of that happening is, in my opinion, like finding a cure for cancer with a one shot vaccine.
In the mean time I believe third party payers are more or less satisfied with leaving the final say in the hands of the managing physicians. This provides them (third party payers) with the least amount of professionals to oversee and scrutinize and that I believe saves them money. Since most of us know that more often than not managing physicians can be difficult to deal with and reluctant to assist us with authorizations. I believe they consider their patient notes and subsequent prescriptions already have documented their position on the treatment in question. Further documentation from them is time consuming and costly in light of the reductions that the third party payers reimbursements have already placed on their services.
I am afraid we are stuck with what we have. 
I think your idea has a lot of merit and makes sense as a method to assure the payer that the patient is getting appropriate care. Trouble is ….I don’t think it’s about that anymore. Sadly, most appropriate in the insurance company’s eyes now is cheapest or none at all.
Just be sure that you get a consent to video/photograph from your patient to
protect yourself.   
Greetings Paul and Kevin,
This is a great idea ! As they say, ” a picture is worth a thousand words”. I have done something similar in the past. In fact it was required by a Case Management group that handled Workmen’s Compensation cases.
First you should contact confirmed sources of authority at Texas Medicaid and determine its usefullness
and if they would actually find the concept usefull in expediting authorizations.  Without this, I believe you would
be waisting your time.
 Hi Kevin,

Video is a powerful tool, I have videotaped every client since 1990-91. Video personalizes the authorization process.  You can also send in the video on a thumb drive with the claim.  The thumb drive is cheaper than all the extra man hours utilized to get the claim approved.  When they see the actual orthotic/prosthetic issue that you are attempting to solve and/or have other examples of outcomes based on your skills for them to judge. The only problem, the insurance companies will say they do not want video, their job is to deny as many claims as possible.  The rebuttal to them is, “I thought you guys wanted evidence, I am just attempting to provide the evidence you require. We would like to provide the proof that we understand the problem and know how to best solve it. ” 

We have also used a sequence of video frames within a document, but the video as you stated would be ideal.
Maybe I’ve been at this for too long and have just become a cranky old _____.  It occurs to me that you’re increasing your cost of securing diminishing returns.  It’s a viable idea but better put to use for those “higher degree of diffaculty” projects which result in better returns. 
Sounds like you already thought of this but make sure you have all the clips locked “down” for HIPPA compliance. 
You have a few hurdles.  First the patients or parents authorization. Second do you have have a secure line, it has to pass state or maybe federal guide lines. Also there is the possibility of giving too much information that could be used against your client such as what could be subjective interpretation that could harm them.  Those are just a few. I think if I spent time I could fine 10 more.  So using a form that limits exposure by asking 10 questions is more secure over a film documentary or clinic documentary.
Good luck, and if it goes through put the story into the “Edge”.
As always, I appreciate your willingness to test new ideas.
 Hi Kevin

Just a second thought, here is another inexpensive option that will definitely be an asset to any clinic..
I believe this is an excellant Idea! the only part I would be concerned with would be posting it to the web. If it were me I would keep the video on a seperate hard drive. this way you could protect it from viruses, hackers etc.
Thank you 
Thanks to all those who took time to reply.  I feel this will be an effective tool, once I find out if it’s legal (HIPPA), feasible, and whether or not funding sources are even interested.  I feel it may be even more beneficial for appeals.  Again, thanks to Paul for this list.   
Kevin C. Matthews, CO/LO
Certified/Licensed Orthotist
Advanced Orthopedic Designs
12315 Judson Rd. Suite 206
San Antonio, TX 78233
Phone: 210-657-8100
Fax: 210-657-8105


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