decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Special Advisory Bulletins / OIG-CMS Special Advisory Bulletin 99-3_Nov 10, 1999 / Prior Aurthorization
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Article Overview
This article summarizes an OIG and CMS special advisory bulletin addressing prior authorization concerns in the context of emergency services and managed care plans. It explains the scope of the federal agencies’ authority, the kinds of stakeholder concerns that were raised, and the general guidance discussed for hospitals and emergency physicians. The piece is relevant to compliance, hospital billing, emergency medicine, and managed care administration.
Why This Topic Matters
It helps readers understand how federal advisory guidance frames prior authorization concerns in emergency settings and why hospitals, physicians, and managed care organizations may need to consider compliance and payment issues together.
What You Will Learn
- The policy context surrounding prior authorization concerns in emergency care
- How OIG and CMS describe the limits of their authority in this area
- The general roles of hospitals, emergency physicians, and managed care plans in the bulletin
- The compliance and payment concerns raised by commenters on the proposed guidance
Who Should Read This
- Hospital compliance staff
- Medical coders and billing staff
- Emergency physicians
- Hospital administrators
- Managed care plan administrators
- Healthcare attorneys and compliance professionals
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