Pre-authorizations (PAs) can be tedious, time consuming, and inefficient; yet, they are necessary in order to obtain reimbursement for ordered tests.
Nurses and others working in ambulatory cancer care settings are likely all-too-familiar with PAs and the frequent pain of those processes, which can often delay necessary care, taking days or weeks to appeal.
The Wisconsin Department of Health Services recently launched the Forward Health Gold Card exemption program that is making PAs a thing of the past. Caught your attention yet? Yeah, me too.
Forward Health is Wisconsin's Medicaid program, and previously -- just like every other state Medicaid program -- they required practices to obtain pre-authorization of CT and MRI services. With the Gold Card exemption program, Forward Health is allowing practices to use decision support systems, which are made up of various algorithms, to determine appropriateness of proceeding with services for themselves. In essence, they are cutting out the "middle man," which I can't help but think will save the state Medicaid program a sizeable amount of money.
Interested providers or practices must apply for Gold Card status in order to use the new decision support systems rather than the former, standard pre-authorization process.
The Gold Card pilot program started in May 2013, so outcome data is limited. Still, this pilot program is extremely innovative and has great potential to reform Medicaid pre-authorization processes, which all states use.
Numerous healthcare groups within Wisconsin -- from statewide healthcare professional societies to large healthcare organizations -- had to work together to make this pilot program possible; that's impressive alone. No doubt others have their eyes on this initiative.
What do you think about this pilot program? Would something like this help your ambulatory cancer care practice? Are there Wisconsin healthcare professionals here who have applied for the Gold Card exemption program or who have used it?