Let's talk about the newly released pre-authorization rule from Medicare. According to CMS, the OIG, Gao, and cert reports from 2007 and later indicate that documentation errors do not trend toward specific suppliers. However, the root cause of improper payments is a lack of appropriate documentation. What do we know right now about the ruling? CMS estimates that the per case time burden of preauthorization will be the same as for prepayment review, which is 30 minutes per submission. So, where do they come up with the 30-minute guideline? That's because they assume you have all the doctor's 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. Furthermore, we know that some audit protection will be afforded to claims that have been pre-authorized. Preauthorization will be focused on specific L codes, not on specific suppliers. Therefore, it will be applied to everyone, 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. 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 that they want to implement this rule gradually and will choose only some of the codes. They might also 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 to chew on this quote...
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