{"id":12320,"date":"2024-07-08T09:37:15","date_gmt":"2024-07-08T09:37:15","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=12320"},"modified":"2024-07-08T10:00:52","modified_gmt":"2024-07-08T10:00:52","slug":"new-prior-authorization-patient-care","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/new-prior-authorization-patient-care\/","title":{"rendered":"New Prior Authorization Codes Elevate Patient Care"},"content":{"rendered":"\n<div class=\"wp-block-rank-math-toc-block has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\" id=\"rank-math-toc\"><h2>Table of Contents<\/h2><nav><ul><li><a href=\"#introduction\">Introduction<\/a><\/li><li><a href=\"#background-on-cpt-codes-and-prior-authorization\">Background on CPT Codes and Prior Authorization<\/a><\/li><li><a href=\"#the-proposal-and-its-withdrawal\">The Proposal and Its Withdrawal<\/a><ul><li><a href=\"#initial-proposal\">Initial Proposal<\/a><\/li><li><a href=\"#discovery-leading-to-withdrawal\">Discovery Leading to Withdrawal<\/a><\/li><\/ul><\/li><li><a href=\"#detailed-examination-of-cpt-codes\">Detailed Examination of CPT Codes<\/a><ul><li><a href=\"#short-vs-long-descriptions\">Short vs. Long Descriptions<\/a><\/li><li><a href=\"#am-as-role-and-communication-gaps\">AMA&#8217;s Role and Communication Gaps<\/a><\/li><\/ul><\/li><li><a href=\"#future-of-the-proposal\">Future of the Proposal<\/a><ul><li><a href=\"#planned-revisions\">Planned Revisions<\/a><\/li><li><a href=\"#potential-impacts-on-healthcare\">Potential Impacts on Healthcare<\/a><\/li><\/ul><\/li><li><a href=\"#am-as-efforts-to-support-physicians\">AMA&#8217;s Efforts to Support Physicians<\/a><ul><li><a href=\"#cpt-handbook-updates\">CPT Handbook Updates<\/a><\/li><li><a href=\"#cpt-assistant-resources\">CPT Assistant Resources<\/a><\/li><\/ul><\/li><li><a href=\"#conclusion\">Conclusion<\/a><\/li><li><a href=\"#fa-qs\">FAQs<\/a><ul><li><a href=\"#1-what-are-cpt-codes\">1. What are CPT codes?<\/a><\/li><li><a href=\"#2-what-is-prior-authorization\">2. What is prior authorization?<\/a><\/li><li><a href=\"#3-why-was-the-proposal-for-new-cpt-codes-withdrawn\">3. Why was the proposal for new CPT codes withdrawn?<\/a><\/li><li><a href=\"#4-what-is-the-ama-doing-to-help-physicians-with-cpt-codes\">4. What is the AMA doing to help physicians with CPT codes?<\/a><\/li><li><a href=\"#5-what-are-the-plans-for-the-proposal\">5. What are the plans for the proposal?<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"introduction\">Introduction<\/h3>\n\n\n\n<p>A recent proposal to enhance the process of reporting prior authorization through Current Procedural Terminology (CPT) codes has been withdrawn. This withdrawal came after a significant discovery by Dr. Alex Shteynshlyuger, revealing that certain prior authorization requirements were already embedded within specific CPT codes.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"background-on-cpt-codes-and-prior-authorization\">Background on CPT Codes and Prior Authorization<\/h3>\n\n\n\n<p><a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-overview-and-code-approval\" target=\"_blank\" rel=\"noopener\">CPT codes<\/a> are a set of medical codes used to describe procedures and services performed by healthcare providers. These codes are crucial for billing and insurance purposes. <a href=\"https:\/\/www.medicaleconomics.com\/view\/prior-authorizations-containing-costs-or-obstructing-health-care-\" target=\"_blank\" rel=\"noopener\">Prior authorization<\/a>, on the other hand, is a process where healthcare providers must obtain approval from a patient&#8217;s insurance company before proceeding with certain treatments or procedures. This step ensures that the services are covered under the patient\u2019s insurance plan.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"the-proposal-and-its-withdrawal\">The Proposal and Its Withdrawal<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"initial-proposal\">Initial Proposal<\/h4>\n\n\n\n<p>Dr. Alex Shteynshlyuger, the director of urology at New York Urology Specialists, proposed a time-based CPT code for prior authorization. His proposal aimed to ensure that physicians are compensated for the time spent on prior authorization claims. The expectation was that this change would reduce the number of claim requirements imposed by insurance plans, decrease the volume of appeals, and ultimately lead to better patient outcomes.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"discovery-leading-to-withdrawal\">Discovery Leading to Withdrawal<\/h4>\n\n\n\n<p>However, upon presenting his proposal, Dr. Shteynshlyuger was informed by the American Medical Association (AMA) that prior authorization was already explicitly mentioned in the detailed descriptions of several CPT codes. This revelation necessitated the withdrawal of his proposal for further revision.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"detailed-examination-of-cpt-codes\">Detailed Examination of CPT Codes<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"short-vs-long-descriptions\">Short vs. Long Descriptions<\/h4>\n\n\n\n<p>Each CPT code is accompanied by a short description that outlines the type of visit or examination. However, longer, more detailed descriptions\u2014which include mentions of prior authorization\u2014are stored in databases that are less frequently accessed by physicians.<\/p>\n\n\n\n<p>\u201cI\u2019ve never seen the long description in my lifetime,\u201d said Dr. Shteynshlyuger, highlighting a significant gap in communication and accessibility of information for physicians.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"am-as-role-and-communication-gaps\">AMA&#8217;s Role and Communication Gaps<\/h4>\n\n\n\n<p>The <a href=\"https:\/\/www.physicianspractice.com\/view\/ama-panel-to-consider-prior-authorization-code\" target=\"_blank\" rel=\"noopener\">AMA<\/a> publishes annual updates in its CPT Changes book and offers an online data manager. Despite these resources, many physicians are unaware of or do not utilize these tools to find detailed information about CPT codes and their prior authorization requirements. The AMA&#8217;s decision to include prior authorization mentions in long descriptions without adequately informing physicians has led to confusion and oversight.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"future-of-the-proposal\">Future of the Proposal<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"planned-revisions\">Planned Revisions<\/h4>\n\n\n\n<p>Dr. Shteynshlyuger plans to resubmit his proposal with dedicated codes that specifically address the time spent by physicians on prior authorization claims. The revised proposal aims to cover scenarios where the current CPT codes are inadequate for reimbursing physicians.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"potential-impacts-on-healthcare\">Potential Impacts on Healthcare<\/h4>\n\n\n\n<p>Introducing dedicated CPT codes for prior authorization could streamline the billing process, reduce administrative burdens, and enhance the ability to study the effects of prior authorization on healthcare delivery. This change could lead to improved patient care and more efficient healthcare systems.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"am-as-efforts-to-support-physicians\">AMA&#8217;s Efforts to Support Physicians<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"cpt-handbook-updates\">CPT Handbook Updates<\/h4>\n\n\n\n<p>In 2021, the AMA updated the CPT codes and guidelines for outpatient evaluation and management services. These updates were intended to help healthcare providers prepare for operational and administrative workflow changes.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"cpt-assistant-resources\">CPT Assistant Resources<\/h4>\n\n\n\n<p>The AMA provides a CPT Assistant resource for its members, offering guidance on coding and billing questions. This resource helps clinicians appeal insurance denials and navigate day-to-day coding challenges. The organization plans to publish new articles to further assist physicians in understanding the complexities of CPT codes related to prior authorization.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"conclusion\">Conclusion<\/h3>\n\n\n\n<p>The withdrawal of the proposal for new prior authorization CPT codes underscores the need for better communication and accessibility of detailed CPT code descriptions. Dr. Shteynshlyuger\u2019s planned revisions aim to address these issues, potentially leading to significant improvements in the healthcare system. The AMA&#8217;s ongoing efforts to support physicians through resources like the CPT Assistant are crucial in navigating these complexities.<\/p>\n\n\n\n<p><span class=\"ui-provider a b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">Discover the latest <a class=\"fui-Link ___1rxvrpe f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link payers&#039; news updates\"><strong>payers&#8217; news updates<\/strong><\/a> with a single click. Follow <a class=\"fui-Link ___1rxvrpe f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link DistilINFO HealthPlan\">DistilINFO HealthPlan<\/a> and stay ahead with updates on <strong>medical advancements<\/strong>. Join our community today!<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"fa-qs\">FAQs<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"1-what-are-cpt-codes\">1. What are CPT codes?<\/h4>\n\n\n\n<p>A. CPT codes are a set of medical codes used to describe medical, surgical, and diagnostic services, facilitating billing and insurance processes.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"2-what-is-prior-authorization\">2. What is prior authorization?<\/h4>\n\n\n\n<p>A. Prior authorization is a process where healthcare providers must obtain approval from a patient\u2019s insurance company before performing certain procedures to ensure coverage.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"3-why-was-the-proposal-for-new-cpt-codes-withdrawn\">3. Why was the proposal for new CPT codes withdrawn?<\/h4>\n\n\n\n<p>A. The proposal was withdrawn after discovering that prior authorization requirements were already included in the detailed descriptions of certain CPT codes.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"4-what-is-the-ama-doing-to-help-physicians-with-cpt-codes\">4. What is the AMA doing to help physicians with CPT codes?<\/h4>\n\n\n\n<p>A. The AMA provides resources like the CPT Changes book and CPT Assistant to help physicians understand and utilize CPT codes effectively.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"5-what-are-the-plans-for-the-proposal\">5. What are the plans for the proposal?<\/h4>\n\n\n\n<p>A. Dr. Shteynshlyuger plans to resubmit the proposal with dedicated CPT codes to address the time spent by physicians on prior authorization claims.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction A recent proposal to enhance the process of reporting prior authorization through Current Procedural Terminology (CPT) codes has been&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/new-prior-authorization-patient-care\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":12323,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[228],"class_list":{"0":"post-12320","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"tag-prior-authorization","9":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12320"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=12320"}],"version-history":[{"count":4,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12320\/revisions"}],"predecessor-version":[{"id":12334,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12320\/revisions\/12334"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/12323"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=12320"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=12320"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=12320"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}