Leading the Way into the Future: Healogics insights, processes and support tools help comply with Medicare Prior Authorization Program for Non-Emergent Hyperbaric Oxygen Therapy Requirements
In 2015, the Centers for Medicare and Medicaid Services (CMS) implemented a three-year project for prior authorization for non-emergent HBO therapy in Illinois, Michigan, and New Jersey. The project's goal is to test whether prior authorization helps reduce expenditures while maintaining or improving quality of care.
COMPLEXITIES OF PRIOR AUTHORIZATION
The HBO therapy prior authorization process is complex, with complications and challenges posed by stringent documentation requirements of Medicare Administrative Contractors (MACs). CMS tell us that in addition to MACs, contractors including Zone Program Integrity Contractors may conduct targeted pre- and post-payment reviews to ensure that claims are accompanied by documentation not required during the prior authorization process. In addition, the Comprehensive Error Rate Testing contractor must review a random sample of claims for post-payment review.
Healogics has the scale, experience and expertise needed to deal effectively with this emerging challenge. We have taken an industry leadership role in working with CMS and select MACs, helping to shape the requirements, process and scope of the program as well as testing prior to implementation of the project. Healogics early investments have resulted in unique insights and learnings, as well as the
development of the expertise, processes and support tools necessary to assist and support our customers with this often complicated and difficult process.
LEVERAGE OUR SUCCESS
As the leader in wound care management, Healogics has invested in a dedicated, experienced staff who have developed solid working relationships with the MACs. This team provides one-on-one support for our Wound Care Center® staff in preparing and submitting a patient record for prior authorization approval.
Drawing upon our relationships with the MACs and experience to date, Healogics has developed a comprehensive suite of tools, training and resources that help our field staff “get it right the first time.”
HEALOGICS HAS THE EXPERIENCED, DEDICATED STAFF AND IN-DEPTH
UNDERSTANDING TO HELP YOU ENSURE THE SUBMISSION IS COMPLETE
THE FIRST TIME.
Healogics provides one-on-one support for our centers, drawing upon a growing base of subject
matter expertise and knowledge. Our investment in leadership and activism has not only yielded
unique insights and learnings, it has benefited the entire medical community by influencing the
development of requirements and scope.
We have a rich array of resources that include comprehensive tools and training designed to
streamline the complex submission process. These include items such as checklists based on Medicare coverage criteria, physician dictation templates, referral source documentation collateral and ongoing communication with key stakeholders.
YOU ARE NOT ALONE
Don’t go it alone; partnering with Healogics will help your organization navigate the increasingly complex and challenging environment around CMS prior authorization. HBO is a critical adjunctive therapy for patients with chronic wounds. Healogics can help ensure that those patients who qualify and need the treatment have the very best chance to receive it.
For more information, contact us at 800.379.9774