Payers Institute Administrative Changes During Crisis
There continue to be major disruptions in the healthcare system due to COVID-19, and most of the major third-party payers have made adjustments to various administrative processes, including prior authorization, quality reporting and telemedicine. The most recent changes being a major announcement from the Ohio Department of Medicaid on Friday regarding prior authorization. Below we have provided the links and summaries to the latest updates from the major payers in Ohio.
Ohio Department of Medicaid
Ohio Department of Medicaid (ODM) has announced a series of changes aimed at increasing flexibility and making access to care easier for Ohioans. These include:
Reducing prior authorization requirements for many medical and behavioral health services. Effective 3/27/2020, the managed care plans will lift prior authorization requirements for all but a few medically necessary services, and defer medical necessity determinations to providers. Providers will have the option to continue to submit prior authorization requests, seek administrative authorization, or bypass prior authorization. According to an ODM release detailing the changes, plan systems are being updated to allow claims to be paid without prior authorization, and all plan systems will be updated no later than April 20, 2020.
As a reminder, ODM also made changes expanding telehealth services to a wide variety of medical, clinical and behavioral health. For more information, please refer to the following informational resources:
Ohio’s Medicare Administrative Contractor has provided a number of different updates regarding policy changes for fee-for-service Medicare.
Additionally, as a reminder, CMS has announced a number of reporting changes over the last several weeks, most notably a delay in MIPS data submission for 2019 and 2020.
Every major commercial insurance company operating in Ohio has issued updates on COVID-19 related policy changes.
Some are general and cover telehealth, prior authorization and treatment of COVID patients, while others are specialty specific. Each company's updates are listed below to help you navigate the policy changes impacting your practice:
Ohio Bureau of Workers Compensation
The Ohio Bureau of Workers Compensation (BWC) has issued guidance for both patients and physicians regarding changes during the COVID-19 crisis. This information covers benefits, telehealth and several other topics.
As you know, Ohio State Medical Association (OSMA) is committed to keeping Ohio physicians informed on state and federal updates related to COVID-19, especially how they impact Ohio’s medical practices and healthcare professionals.