Medicare prior authorization Form 2018-2023

Medicare prior authorization Form: What You Should Know

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Let's talk about the newly released pre-authorization rule from Medicare according to CMS the OIG Gao and cert reports from 2023 and later indicate the documentation errors do not trend toward specific suppliers but that the root cause of improper payments is a lack of appropriate documentation what do we know right now about the ruling CMS estimates the per case time burden of preauthorization will be the same as for prepayment review 30 minutes per submission where do they come up with the 30 minute guideline that's because they assume you have all the doctors notes prior to submitting any claim we also know that 84 L codes are on the list of potential preauthorization items response times according to the ruling will be 10 days for an initial submission and 20 days for resubmits we know that some audit protection will be afforded to claims that have been pre-authorized we also know that preauth will be focused on specific L codes not on specific suppliers so it will be applied to all whether you have a good billing history with Medicare or not what we don't know right now about the rule is the date for implementation that's right CMS has published the final rule but has decided not to start implementation yet they will give a 60-day notice when they come up with a date we also don't know which of the 84 L codes will be required to have preauthorization CMS States they want to implement this rule gradually and so we'll choose only some of the codes and might only implement it in certain geographic areas CMS appears to be on a different page than piano again luckily in the body of the pre-authorization rule they've provided some insight into their position I leave you...