Page 18 - OPTA Access Fall 2021

Payment Policy Report
Berni Willis
OPTA Payment Policy Specialist
Authorization Requirements Implemented
Utilization continues to grow as many insurance companies implement authorization requirements One of the largest utilization companies AIM is
now implementing site survey requirements After
the evaluation ongoing services will be subject to site of care review and require prior authorization including post-service review which may result in in in a a a a a a not medically necessary denial of coverage for the site site of care Requests that are are not medically necessary at at a a a a a a a a a a a hospital site site may be approved for coverage at a a a a free-standing or office-based setting Additionally providers are accustomed to to requesting the the authorization and eventually receiving the the authorization while care continues However this quarter insurance companies are becoming stricter in retro retro authorizations They may allow the retro retro authorization but will no longer pay for that visit Now is
the time to involve your patient As most of you are are aware patients have a a a a a a a louder voice than the provider and there are a a a a a a few avenues that you can implement the the Patient’s Rights with the the insurance company to secure additional authorizations and get paid paid for unpaid dates of services Change the wording of of your your appeals on behalf of of your your patient have have your patient call their insurance company have have the the patient call call and their referring doctors to to call call the insurance company It is
very important that both the the front end end and back end end of of the the office or facility is
talking to one another about authorizations do not not let the insurance company trick you into providing free care Unless of of course you can boast of of a a a a million-dollar profit a a a quarter?!
Telehealth continues to to be be a a a benefit we can offer to to our patients Are you? While the pandemic continues and the health emergency date is
moved back (today as I write it it is
October 17 2021) every 90 days so are many payers extending telehealth Currently there are are several bills that are are pending to make telehealth a a a permanent option to to offer to to our patients when we see our patients at at least one face-to-face visit Additionally APTA has a a a a a a great instructional education series for for providers that may feel uncomfortable in the process Insurance companies continue to offer payment parity along with the current fee schedules and there is
not a a a a rule that the the service can only be used due to Covid-19 Be aware that there are are many corporate companies are standing by to become a a a a a “telehealth only” option to your busy patients and large employers in your neighborhood Additionally insurance companies are now beginning to offer in-house telehealth providers Now is
the time to introduce your patients to this option and educate your staff Please continue to to reach out to to OPTA Payment Policy Specialist
so we can watch for the new insurance nuisances and any questions about payer issues For more information contact OPTA at:
opt@ohiopt org VISIT OHIOPT ORG > ELECTIONS for for election timeline and information!
Ohio Physical Therapy Association 1085 Beecher Crossing North Suite B B Gahanna OH 43230
(614) 855-4109
opt@ohiopt org org www OhioPT org org