New Prior Auth Requirements for Novitas for facet procedures

[Greenbayslacker]

They send it back in and I review. If negative, f/up appt scheduled. If positive my assistant documents %relief and duration, scan pain log into emr and second MBB ordered.

We've had kickbacks because the % relief documentation on the phone was by an MA and not RN/MD

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[Dr. Ice]

Everyone is coming back in all the time. Not gonna change that stance now. I’ve told lots of patients to reach out to their congress people if they have a problem with it. I’m not sitting on the phone for hours to deal with denials any more than I already have to

 

[GlowInTheDark]

United is now making us pre-auth for almost every single CPT we do. This started about 1-2 weeks ago. I’m in private practice in New England. The online auth portal is essentially useless, office staff are having to sit on phone and fax notes like it’s the 1990s.

Of course they won’t justify why they’ve change this so we’re exploring legal options.

 

[DrMDAware]

United is now making us pre-auth for almost every single CPT we do. This started about 1-2 weeks ago. I’m in private practice in New England. The online auth portal is essentially useless, office staff are having to sit on phone and fax notes like it’s the 1990s.

Of course they won’t justify why they’ve change this so we’re exploring legal options.

I wish they paid us like the 1990s

 

[jsaul]

I wish they paid us like the 1990s

folks this is no joking matter. we all sit here and joke about and complain online but the bottom line is - the way its going, there is not going to be much insurance coverage for pain procedures anymore. its heading that way and the ball is rolling and going to chase us down like the big boulder in the opening of raiders of the lost ark.

 

[Agast]

Does anyone else here have to participate in MIPS? Previously you had 4 days to sign off on a chart, apparently it’s going to 48 hours now. I always prioritize notes that are needed for prior authorization/procedures and sign the other ones later. My documentation is slow partly because I’m trying to capture all the stuff insurance jumps on to deny injections and spelling out MRI findings so reviewers don’t waste my time because they can’t be bothered to read anything. So if I don’t meet this quality measure, Medicare will decrease our group reimbursement. It feels like I’m getting squeezed on all sides. Like kill me over what I write and then kill me for not writing it fast enough. Fuuuuuu

 

[lobelsteve]

Does anyone else here have to participate in MIPS? Previously you had 4 days to sign off on a chart, apparently it’s going to 48 hours now. I always prioritize notes that are needed for prior authorization/procedures and sign the other ones later. My documentation is slow partly because I’m trying to capture all the stuff insurance jumps on to deny injections and spelling out MRI findings so reviewers don’t waste my time because they can’t be bothered to read anything. So if I don’t meet this quality measure, Medicare will decrease our group reimbursement. It feels like I’m getting squeezed on all sides. Like kill me over what I write and then kill me for not writing it fast enough. Fuuuuuu

Depending on EHR have the MIPS stuff autopopulate. If not, have MA or check in folks trained to knock out those questions and place in chart.

 

[clubdeac]

We've had kickbacks because the % relief documentation on the phone was by an MA and not RN/MD

We started to get the same ****. It’s complete insanity

 

[Dr. Ice]

We started to get the same ****. It’s complete insanity

Everyone comes in all the time following procedures. No MA or mid level does anything for me. Just another excuse to deny. Don’t need more headaches

 

[GlowInTheDark]

folks this is no joking matter. we all sit here and joke about and complain online but the bottom line is - the way its going, there is not going to be much insurance coverage for pain procedures anymore. its heading that way and the ball is rolling and going to chase us down like the big boulder in the opening of raiders of the lost ark.

Seriously though…what is to be done? Is the horse out of the proverbial barn?

Insurers are more vertically integrated (United/Optum/SCA for example)…physicians are in their pockets as employees. We have at least 5 societies in the pain field…but all we’ve seen in the last 5 years is tightening of requirements and clawbacks.

I’m a year into PP and already asking to myself…how the hell is this going to be a career in 10-15 years. Maybe you’ve all done that?

 

[DrMDAware]

We started to get the same ****. It’s complete insanity

Outrageous.

They wanna pay NP/PA rates (or less!) for an MD/DO in addition to the MD/DO taking medical liability.

Seriously though…what is to be done? Is the horse out of the proverbial barn?

Insurers are more vertically integrated (United/Optum/SCA for example)…physicians are in their pockets as employees. We have at least 5 societies in the pain field…but all we’ve seen in the last 5 years is tightening of requirements and clawbacks.

I’m a year into PP and already asking to myself…how the hell is this going to be a career in 10-15 years. Maybe you’ve all done that?

1) Find alternative revenue streams (including using ur medical knowledge as well as outside of medicine)
2) Save lots of money while you can
3) Hire NP/PAs (I say F it - if insurers and patients want a knowledgeable physician they should not play silly games and should pay up or expect care on the same day. Don't make us physicians feel greedy or fight amongst ourselves. The social (and now real contract) is broken. You want concierge-level care gramps? Karen, you wanna cut the line? Pay up.)
4) Dabble in your primary specialty
5) Join a hospital. They absolutely juice the returns and abuse the SOS but they do kick back some steady scraps....and no one is pushing the big boyz around.
6) Do something different than everyone else in the pain space.
7) Lower your overhead (overseas VAs, scribes, etc, avoid buying into an ASC)