Practice Management > > Practice Management– A Texas law to exempt service providers from previous permission hasn't exercised as hoped
by Joyce Frieden, Washington Editor, MedPage Today December 10, 2024
Have you wanted you could be exempt from previous permissions, specifically since your treatments or prescriptions are often authorized?
That's the concept behind “gold card” laws some states have actually executed, however the laws have not constantly exercised rather the method fans have actually visualized.
Take Texas. Under that state's gold card law, passed in 2021, “a health care company or an insurance company that utilizes a preauthorization procedure for health care services might not need a doctor or supplier to get preauthorization for a specific health care service if, in the most current 6-month examination duration, the health care company or insurance provider has actually authorized or would have authorized not less than 90% of the preauthorization demands sent by the doctor or supplier for the specific health care service.” Just like other gold card laws, the benefit is expected to be immediately given, without the service provider needing to do anything.
That 90% figure might sound like a simple bar to clear, just 3% of the state's health care service providers have actually so far gotten a gold card, according to a January 2023 study from the Texas Department of Insurance. “We do not have any information to show that the portion will increase,” a representative for the department stated in an e-mail.
Granular CPT Codes
Zeke Silva, MD, chair of the Council on Legislation at the Texas Medical Association (TMA), stated that in getting the law passed, “we had actually hoped if a doctor did a treatment that prevailed for them, that remained in their sphere of knowledge, and for which they generally gotten prior permission approval, moving forward, they would no longer need to go through the procedure. The objective was extremely sensible.”
“it's ended up being hard for doctors in that scenario to please the limit to make a gold card,” he continued, keeping in mind that a doctor should have a specific service authorized a minimum of 5 times throughout the 6-month duration being thought about. “While that seems like it would not be difficult to attain, CPT [Current Procedural Terminology] coding is extremely granular.”
In radiology– Silva's specialized– “there's a various CPT code for a chest CT without contrast, with contrast, and then with and without contrast, which is great since it permits you to report what you're doing in a relatively granular style,” he stated. “The drawback is, if you're a pulmonologist and you're attempting to get prior permission for a chest CT, a few of your clients may require contrast, some might not, and some might require both,” so getting 5 approvals for a specific CPT code all of a sudden ends up being more complex. The exact same holds true for collecting previous permissions for the very same medication with various does and various healing programs.
He included that there's another issue,
