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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.

 

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?
 
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