Need advice with authorizations and scheduling.

[cameroncarter]

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1. When do you schedule patients with non-Medicare insurance? (After auth obtained or do you pre-emptively book them ~10-14 days in advance?)
2. How do I learn which cases need auth vs not?
3. “Urgent” cases like a blood patch- do I need auth for these?

 

[10KHertz]

I also have a scheduling question for the board. Looking to add another APP (2 total , one attending ). Are you guys having the APP see the patients , present the plan, and sign off on all patients ? Kinda like fellowship style , so you have a finger in all patient plans. Or are you trusting your APP is offering multimodal options to all patients ? Curious on practice styles …

 

[DODOCSS]

I also have a scheduling question for the board. Looking to add another APP (2 total , one attending ). Are you guys having the APP see the patients , present the plan, and sign off on all patients ? Kinda like fellowship style , so you have a finger in all patient plans. Or are you trusting your APP is offering multimodal options to all patients ? Curious on practice styles …

I tend to not put fingers in my patients, ymmv

 

[lobelsteve]

I tend to not put fingers in my patients, ymmv

How do you make the pocket?

 

[callmeanesthesia]

I also have a scheduling question for the board. Looking to add another APP (2 total , one attending ). Are you guys having the APP see the patients , present the plan, and sign off on all patients ? Kinda like fellowship style , so you have a finger in all patient plans. Or are you trusting your APP is offering multimodal options to all patients ? Curious on practice styles …

Depends on their prior pain/spine experience. I see all patients with them and schedule them very lightly while they are getting up to speed, first 1-2 months. I also have them spend part time shadowing me in clinic and procedures. As they get more confident and are able to present a correct assessment and plan I start letting them come get me when needed, and adding patients on. I instruct them to have a low threshold to come grab me if they’re not sure, but a follow up on a successful MBB doesn’t usually need my input.

 

[cameroncarter]

1. When do you schedule patients with non-Medicare insurance? (After auth obtained or do you pre-emptively book them ~10-14 days in advance?)
2. How do I learn which cases need auth vs not?
3. “Urgent” cases like a blood patch- do I need auth for these?

bump

 

[Orin]

1. When do you schedule patients with non-Medicare insurance? (After auth obtained or do you pre-emptively book them ~10-14 days in advance?)
2. How do I learn which cases need auth vs not?
3. “Urgent” cases like a blood patch- do I need auth for these?

1. This is a process question for your practice. We book them expected on historic averages for their insurance. We don't book until all the criteria are met like a psych eval for an SCS. Our docs shouldn't order stuff they know won't get authorized. If you're really busy, you can obtain auth and then plug them in later as you go as it is valid for weeks. If you're not busy, then post them while waiting.

2. Assume everything needs authorization initially, but if you've got someone in your practice that has done this before, they'll be able to build a grid of insurance X, CPT Y, PA needed or not. A lot of this is locally driven. Some of this also depends on the diagnosis you're injecting for.

3. An urgent case like a blood patch for a PDPH generally does not require a prior authorization, but you oughta always check. Again, your team should have that list built up, but all the insurance processes have some sort of urgent authorization pathway to verify that patient W with insurance X can have CPT Y done for ICD10 Z.

Ideally state pain societies or other local contacts would curate that list for practices, but I'm not aware of that.

 

[Orin]

I also have a scheduling question for the board. Looking to add another APP (2 total , one attending ). Are you guys having the APP see the patients , present the plan, and sign off on all patients ? Kinda like fellowship style , so you have a finger in all patient plans. Or are you trusting your APP is offering multimodal options to all patients ? Curious on practice styles …

I like the fellowship style for APPs, but in reality I don't think that is sustainable or necessary in PP. If I had to design a process, each new APP would do the fellowship style for 3-6 months, graduating to solo flight based on my comfort with their plans, notes, and management styles. I need to learn them, and they need to learn me.

On going though, I would want set times/days a week or month where we could do fellowship style touch ups for ongoing supervision/discussion of complex cases or chart reviews.

Classically in my last academic practice, faculty see them every 12 months, APPs every 1-3 months, procedures PRN.

 

[Pain Applicant1]

1. When do you schedule patients with non-Medicare insurance? (After auth obtained or do you pre-emptively book them ~10-14 days in advance?)
2. How do I learn which cases need auth vs not?
3. “Urgent” cases like a blood patch- do I need auth for these?

I don't preauth any pts for office visits as most are PPOs and I'm in network with most. Worker's comp is a different story. I tend to avoid PI. Some pts have HMOs but they're few and far between. Those visits are denied but usually, the payer allows for a retro auth. More nonsense and hurdles by payers so they can weasel out of paying. I follow through though. I download and fill out the auth form, send it to the PCP for signature, and then send it to the payer.

Urgent cases in pain??? I don't see them. They can all wait at least a day or so. Every single procedure gets authorized, even TPIs. Eventually, you'll figure out which payers don't require auths on which procedures but I would still auth all of them as they change their reqs. Payers love to deny. Don't help them. Most auths can be done via websites but not all. When you call, have your front desk person do other work while waiting on hold.

 

[cameroncarter]

I don't preauth any pts for office visits as most are PPOs and I'm in network with most. Worker's comp is a different story. I tend to avoid PI. Some pts have HMOs but they're few and far between. Those visits are denied but usually, the payer allows for a retro auth. More nonsense and hurdles by payers so they can weasel out of paying. I follow through though. I download and fill out the auth form, send it to the PCP for signature, and then send it to the payer.

Urgent cases in pain??? I don't see them. They can all wait at least a day or so. Every single procedure gets authorized, even TPIs. Eventually, you'll figure out which payers don't require auths on which procedures but I would still auth all of them as they change their reqs. Payers love to deny. Don't help them. Most auths can be done via websites but not all. When you call, have your front desk person do other work while waiting on hold.

I should’ve clarified- mainly when do you schedule procedures after you see someone in clinic? I’ve either booked them to far away (and I got approval early) so had to reschedule a couple of patients (while we’re still waiting on auth)

 

[Pain Applicant1]

I should’ve clarified- mainly when do you schedule procedures after you see someone in clinic? I’ve either booked them to far away (and I got approval early) so had to reschedule a couple of patients (while we’re still waiting on auth)

I have the front desk contact them once authorization is received to schedule their procedure and not before. For whatever reason, there seem to be more denials now so I have to appeal often.

 

[Ronin1]

We usually schedule no earlier then 10 days out due to delays in authorization. It’s usually not an issue as I’m booked out for 2-3 weeks always. SCS we schedule 5-6 weeks out

 

[RoloTomassi]

Schedule 1-2 weeks out when you order. Make them commit to a date just like your dentist. If auth not back, call ahead to push it out. Otherwise they'll be in the wind and your staff will have to chase them with phone calls to get them scheduled.

 

[Ducttape]

keep in mind the insurance carrier.

if straight Medicare, book them a week out.

if "good" private insurance, same thing.

if straight Medicaid, then book them 2-3 weeks out.

if Medicaid Option or Essential plan, expect Denial. tell them that your office will call them when approved.

 

[Multimodal]

keep in mind the insurance carrier.

if straight Medicare, book them a week out.

if "good" private insurance, same thing.

if straight Medicaid, then book them 2-3 weeks out.

if Medicaid Option or Essential plan, expect Denial. tell them that your office will call them when approved.

I think this sums out how we schedule too. I would add workers comp is always a wait for phone call situation as they take forever. If medicare (dis)advantage plan, expect a wait and probable/possible denial for bogus reasons.

 

[afob100]

We do this:

BCBS in state, 3 business days out

BCBS federal - no auth needed

Medicare - 3 business days

Aetna/United/Cigna - 20 business days although we usually get auth sooner

Workers comp - wait till auth from case manager before scheduling