Medicare Requiring pre-auth for facet related procedures

[buddababa]

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Just as title says
Part A&B, requiring prior auth for medial branch blocks and RFAs etc now.

 

[callmeanesthesia]

Appears to be only if performed in HOPD setting?

 

[oneforfighting]

Source?

 

[buddababa]

Source?

my hospital pre-cert department

 

[buddababa]

Source?

Appears to be only if performed in HOPD setting?

Perhaps

 

[TheLoneWolf]

Am I the only person who feels that there are entities actively placing obstacles to procedures so that over time it becomes untenable to performing them routinely or to bury you in paperwork to add to overhead burden so that it's far lower in the treatment pathway? I do beleive there is an effort to shunt the pain patient population to be mismanaged by primary care visits and generic meds because at the end of the day it is far more cost efficient.

 

[drusso]

Am I the only person who feels that there are entities actively placing obstacles to procedures so that over time it becomes untenable to performing them routinely or to bury you in paperwork to add to overhead burden so that it's far lower in the treatment pathway? I do beleive there is an effort to shunt the pain patient population to be mismanaged by primary care visits and generic meds because at the end of the day it is far more cost efficient.

It's not happening by accident.

 

[pmrmd]

Just as title says
Part A&B, requiring prior auth for medial branch blocks and RFAs etc now.

These procedures should not be allowed to be performed in the HOPD setting in my opinion. SOS too expensive for the ease of the procedure. Office or ASC only.

 

[Dr. Ice]

If I had it my way, I’d do everything in the office

 

[deleted131481]

These procedures should not be allowed to be performed in the HOPD setting in my opinion. SOS too expensive for the ease of the procedure. Office or ASC only.

I do them at my HOPD, and we are unfortunately tremendously wasteful in time, staffing, and supplies/equipment. If the margins were thinner I'm sure there would be a bigger push to run things lean.

 

[pastafan]

These procedures should not be allowed to be performed in the HOPD setting in my opinion. SOS too expensive for the ease of the procedure. Office or ASC only.

They should be allowed in all 3 settings, only pay the same.

 

[Centurion38]

I encourage people to go to the CMS website and read the Federal Register document. These changes are mostly a response to a massive fraud scheme where TPI's were being done in the office and billed as "facet injections." Medicare was billed fraudulently for (and paid) tens of millions of dollars in false claims.

It wasn't evil, greedy HOPD doctors doing these BTW

 

[MitchLevi]

These procedures should not be allowed to be performed in the HOPD setting in my opinion. SOS too expensive for the ease of the procedure. Office or ASC only.

This is exactly my opinion.

 

[Ferrismonk]

These procedures should not be allowed to be performed in the HOPD setting in my opinion. SOS too expensive for the ease of the procedure. Office or ASC only.

You're basically describing the entire existence of HOPD. A HOPD is just an office that the hospital owns. I agree it's ridiculous that everything gets paid more in this setting (office visits too remember).

This is what has led (in part) to hospitals buying up all the PCPs.

 

[pmrmd]

I’m

You're basically describing the entire existence of HOPD. A HOPD is just an office that the hospital owns. I agree it's ridiculous that everything gets paid more in this setting (office visits too remember).

This is what has led (in part) to hospitals buying up all the PCPs.

Yes. I’m weary of the “not-for-profit” hospital systems destroying private practice at the patient’s expense in their quest for market share. The general masses are fed physician-extenders for sake of “efficiency” while they funnel those patients into their own imaging centers, therapy centers, and specialists, all of whom they squeeze to the max for their bottom line.

 

[SpineandWine]

I think rather than being upset at HOPD, I wish physicians could own them (just like an ASC) at more ease

 

[drusso]

I think rather than being upset at HOPD, I wish physicians could own them (just like an ASC) at more ease

There are bipartisan efforts to make this happen: Patient Access to Higher Quality Care Act. Obama screwed all MD/DO's by caving to Big Hospital by agreeing to ban physician-owned hospitals in order to pass ObamaCare. There was no evidence to support the ban. It was just politics. Hospitals did not want physicians to benefit from SOS.

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www.statnews.com

S.470 in the Senate and HR 977 in the House

Lankford, Colleagues Push for Greater Health Care Access for Oklahomans, the Nation - Senator James Lankford

OKLAHOMA CITY, OK – Senator James Lankford (R-OK) and his colleagues today announced the reintroduction of the Patient Access to Higher Quality Health Care Act, which removes the Affordable Care Act’s (ACA) ban on the creation and expansion of new physician-owned hospitals (POHs) and allows POHs...

www.lankford.senate.gov

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