A proposal to track prior authorization using CPT codes was pulled back for revision after a surprising finding. An urologist, advocated for the plan to compensate physicians for time spent on prior authorization requirements. He also hoped it would streamline the process and improve patient care.
However, the American Medical Association (AMA) informed urologist that existing CPT codes already mention prior authorization in their detailed descriptions. These descriptions are rarely used by physicians, who mainly rely on the shorter code summaries.
Unveiling the Hidden Prior Authorization Details
Each CPT code has a short description and a longer, more detailed version. The longer descriptions, accessible in purchasable databases, contain the prior authorization references. Urologist highlights the lack of awareness about these extended descriptions: “I’ve never seen the long description in my lifetime.”
The AMA publishes annual updates and offers online resources, but most physicians are unaware of how to access or utilize this information for prior authorization details.
Limited Applicability and Future Plans
The AMA shared the six relevant CPT codes with media outlets. Prior authorization is only mentioned in the extended descriptions, not the short codes most doctors reference. Urologist questions why the AMA hasn’t made this information more readily available.
Furthermore, these codes only allow billing for prior authorization in specific scenarios involving same-day evaluations by physicians. Time spent by assistants or specialists doesn’t qualify. While these codes offer some reimbursement, urologist plans to resubmit his proposal for “dedicated codes” to cover a wider range of situations.
The Potential Benefits of Dedicated Codes
Dedicated CPT codes for prior authorization could offer several advantages:
Compensation: Physicians could be reimbursed for time spent on all prior authorization Requirements, not just those under specific codes.
Improved Data Collection: Dedicated codes would allow for better tracking of prior authorization processes, leading to potential improvements in healthcare delivery.
The AMA is committed to supporting physicians with resources like the CPT Assistant, which helps with coding, billing questions, and appealing insurance denials. They also plan to publish an article on utilizing existing codes for prior authorization tasks.
Allzone MS and Revenue Cycle Management (RCM)
While CPT code development is ongoing, companies like Allzone MS can offer solutions for managing outstanding accounts receivable (A/R) within the revenue cycle. These services might include:
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Accurate medical billing and coding, Allzone MS’ another area of expertise, can minimize A/R issues by ensuring claims are submitted correctly, reducing denials and delays in receiving payments.