Payers may forgo PA restrictions in more collaborative model
Medicare & Reimbursement Advisor Weekly, November 20, 2009
Even if the products you support are orals for cardiovascular conditions, the following may be helpful to give you insight into a plan’s new-age thinking about utilization management. A flurry of single-source biologics with attractive side effect profiles is expected to enter the cancer care market without competition in the next few years. Requiring prior authorizations (PA) on the coming wave of expensive oncology-specific biologics is an option “but not Aetna’s preferred option as it might preclude payers from engaging in relationships with community oncologists, academic centers, hospitals, and cancer centers,” says Aetna’s Ira Klein, MD, medical director of oncology condition analysis. In lieu of a PA, Klein says payers could try a single-specialty arrangement with an oncology provider, or build a private label insurance product in which the plan acts as a third-party administrator.
PAs would close the door to these arrangements and stall recent collaboration among oncology groups and payers.
Editor’s note: E-mail bcote_18@hotmail.com to view the full article.
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Q&A: Primary, principal, and secondary diagnoses
- Practice the six rights of medication administration
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- CMS seeks comment on quality measures
- Complications from immobility by body system
- Coding Clinic reiterates guidelines for provider documentation
- Prevent dehydration with nursing interventions
- E-mailed
-
- Capturing start and stop times for infusions
- Q&A: Sepsis as a primary diagnosis
- Note from the instructor: Billing Outpatient Laboratory Services - TOB 131 vs. TOB 141
- Learn how to read an OP report
- Inpatient-only procedures: Accuracy helps avoid denials, ensure compliance
- Don't forget the three checks in medication administration
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding Clinic reiterates guidelines for provider documentation
- Clinical Corner: Revisiting respiratory failure
- Clear up confusion surrounding observation services
- Searched
