Struggling w/keeping track of Insurance Auths

[HealinghandsRN]

Hello All,

Please be kind enough and inform me how other agencies handle clients that have regular insurance vs medicare........and when a patient is admitted, do u put in for the same amount of insurance auths as u put for MD orders?? I find there are far too little insurance auths requested at one time for 2w8 md orders.... I am having a hard time keeping track. Any Suggestions and how does your agency handle the auths? Thanks for any input.

[cookie102]

i actually do the auths for the agency i work for, and i hate that part of the job!!! i always try to get the most i can for the cert period, some companies will give it and others give only 2 weeks, some until the next MD appt, and oh boy do they know when the patient is going to the MD, medicaid is the worse as they won't retro auth....i flip thru my auth book on a daily basis to try and keep ahead!! i'd be interested in an easier way, but i don't know if one exists

[HealinghandsRN]

Thank u for your response. I am new to HH and we are the case managers of our own patients.....do the nurses have to give u auth forms each time? Or do u have another system? The most I really ever see is 5 at a time even if the freq is 2w6 does that make sense? Shouldn't they at least give them according to the docs orders? Do the nurses that go out into the field also case manage at ur place? Thanks for all your input.

[cookie102]

what seems to work best for me is just keeping up with the nurses notes, i tried to have them fill out an update for me, but it just never worked out, they won't give you the "2w6" because heaven forbid they give it to you and you actually use it, they are afraid of inapproprite use of visits. i guess i understand it from their point of view, but from mine i don't, the nurses where i work do all other aspects of casemanagement except getting auths, but i understand there are alot of agencies that do it your way, think i am going to suggest that...i know it really makes the nurse think before they just "make a visit"

[CseMgr1, ASN, RN]

The nurse who did the insurance auths at the HHA where I used to work was constantly pulling her hair out...not because she was unable to get any approvals, but because the nurses were constantly behind on their documentation. Even though HIPPA regs demands that they be inputted and locked within 48 hours of a visit, many of the nurses were days and even weeks behind on theirs. To try and enforce these regs was futile, as upper management was constantly undermining my authortity as Clinical Manager...which was one of many reasons why I quit.

[tracy3528]

I don't know if this would work for everyone, but it works in our office.

The scheduler only schedules as far into the certification period as the pre auths allow, she then places a task in her outlook calender one week prior to the patient's last approved visit. At that point she gives a "notification for additonal visits" (a form) to all disciplines involved, the billing office, and the nursing supervisor. The disciplines (SN, PT, OT) etc that would like additional visits do a brief justification summary note and gives it to our "in office" case manager/supervisor (they have 48 hours to turn these in). Our "in office" case manager/supervisor gets additional visits approved and documents what is approved, notifies disciplines via voice mail, and gives a copy of the authorization documentation to the scheduler who then schedules the visits for as long as authorized, puts a task on her Outlook calender... (and the cycle continues)

Hope this helps someone