Good morning, ProviderNation.
The Centers for Medicare & Medicaid Services (CMS) got their manual medical reviews (MMR) process off the ground but “did not issue complete guidance” on preapproval requests, leaving the Medicare Administrative Contractors (MACs) “unable to fully automate systems for tracking preapproval requests,” the fine folks at the Government Accountability (GAO) have found in a new report that’s just chockfull of information (and Abbreviations!).
The English version goes something like this…
Here’s GAO’s version:
“The MACs we interviewed stated that receiving this guidance 1 month before the October 1st start of the MMR process made it difficult for them to adequately prepare and establish systems for reviews of preapproval requests. For example, one MAC said that because of the short turnaround time for implementation, it was not prepared for the high volume of preapproval requests received in the early weeks of the process, which caused it to approve requests without reviewing them. Another stated that it could have better managed the volume of preapproval requests received if it had more time to develop needed support systems. This late guidance also made it difficult for the MACs to train temporary staff assigned to the MMR process in a timely way; two MACs noted that they were still training temporary staff in October, after the start of the process, and one added that this made it difficult to manage the volume of preapproval requests received in October.”
And the fine folks at the Kaiser Family Foundation (KFF) take a look at who owns what in the long term care world.