Resource AMA Articles

Bill to streamline prior authorization in Medicare Advantage Plans​

Specifically, the bill would:

• Require Medicare Advantage plans to implement electronic prior-authorization programs that adhere to newly developed federal standards, as well as establish real-time decision-making processes for items and services that are identified as “routinely approved.”
• Mandate that Medicare Advantage plans issue accelerated prior authorization decisions for all other services in Medicare Part C.
• Enhance transparency by requiring Medicare Advantage plans report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals and denials.

Big step for bill to streamline prior auth in Medicare Advantage

A powerful House committee has passed a bipartisan bill to rein in onerous delays. Learn how the AMA is tackling prior authorization.

www.ama-assn.org

 

[Lori]

AMA Reviews the myths​

AMA provides regulatory clarification to physicians and their care teams to aid physicians in their day-to-day practice environment.

Read the Myths & Truths here:

1. Protected health information (PHI) disclosures​

   1. Does HIPAA require that health care providers obtain patient authorization to disclose PHI for treatment purposes?

2. Mental health​

   1. Must licensing/credentialing bodies probe into clinicians’ past mental health?

3. Home health agency plan of care (POC) certification​

   1. How should physicians sign home care plan of care certifications and recertifications?

4. Documenting time for each task during outpatient visits​

   1. Are physicians and other qualified health professionals required to document the time spent on each specific task associated with an outpatient visit?

5. Online patient reviews​

   1. Are physicians prohibited from responding to online patient reviews?

6. Preventive/wellness and evaluation and management (E/M) services​

   1. Can physicians bill for both preventive and E/M services in the same visit?

7. EHR documentation​

   1. Are clinical support staff required to log out of EHR between documentation?

   2. Related Coverage​

8. Verbal orders​

   1. Are there regulatory prohibitions on the use of verbal orders?

9. Ancillary staff and/or patient documentation​

   1. Who on the care team can document components of E/M services and what is the physician required to do?

10. Commercial health plans and E/M codes​

    1. Are commercial health plans required to adopt revisions to the E/M codes?

11. Computerized Provider Order Entry (CPOE)​

    1. Can a nurse, certified medical assistant (MA) or non-credentialed staff enter orders in the EHR as requested by the physician?

12. Extended prescription duration​

    1. How does an extended prescription duration help your patients and your practice?

13. Food and drink contamination in work spaces​

    1. Who determines where physicians and other health care workers can eat or drink while at work?

14. Medical student documentation​

    1. Are teaching physicians required to re-document medical student entries in the patient record?

15. Pain assessments​

    1. Are clinicians required to ask patients about pain during every consultation, regardless of the reason for the visit?

 

[Lori]

Errata and Technical Corrections – CPT® 2023 Date: June 1, 2023

https://www.ama-assn.org/system/files/2023-cpt-corrections-errata.pdf?utm_source=SFMC&utm_medium=email&utm_term=6222023&utm_content=HS_Email_Comm_CPT_News_062223&utm_campaign=CPT%20News&utm_asset_name=CPT%20News&utm_channel_name=