authored by Rep. Craig Snow, R-Warsaw, incentivizes providers and insurers to enter reimbursement structures that focus on patient outcomes, rather than the services themselves, in exchange for dropping some prior authorization requirements. Both are awaiting floor votes and seem likely to advance.
Meanwhile, two weeks had gone by. The patient went to the emergency room instead to get the tests, along with a litany of other tests, costing her thousands of dollars.The sheer workload involved has increased hospital workforces significantly. Just in the last three months, Rush Memorial Hospital in Rushville, Indiana, has hired three new staff members in their surgery department specifically to handle prior authorizations, said Julie Slinker, senior director of revenue cycles.
Denials mean appeals, and appeals can take up to a month, she said. Patients inevitably backslide and potentially miss work; physicians feel burned out., is going through this with a longtime patient who has Down syndrome and autism. The 14-year-old girl had her sessions cut in half, and then down to zero because she wasn't making enough progress. Nation filed an appeal.
Of the 50 services that would be exempt from prior authorization altogether in Brown's Senate Bill 400, five are for services Ugoletti's son needs, from speech therapy to gait training exercises, meaning the Ugoletti family would be able to just focus on his care without worrying about getting new approvals every six months.
In other words, because providers wouldn't be reimbursed for every little medical test they order, the thinking is doctors would be more judicious. These kinds of contracts are generally associated with less need for prior authorization, according to aby the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University.
Preddie Allen, the school teacher, could benefit from the momentum initiated this year if, say, her health provider follows the provisions in House Bill 1003 and negotiates down the need for prior authorizations. For now, she was able to obtain a limited number of samples of the medicine she needs, Ubrelvy, while she waits for the results of her prior authorization.