Advocacy & News

Medicare Advantage Prior Authorization Survey

Help AMRPA’s advocacy efforts:
Complete the AMRPA Medicare Advantage Prior Authorization Survey
August 1-31, 2021

AMRPA is asking inpatient rehabilitation hospitals and units to track prior authorization practices of Medicare Advantage plans for the month of August 2021. The requested information will be crucial for AMRPA’s advocacy efforts to address ongoing concerns with patient access for Medicare Advantage beneficiaries. Below is information you need to participate in the survey and how your hospital can implement a plan for tracking authorizations before the August 1, 2021, start date for data collection.

To answer questions about the survey, AMRPA held an informational call on Tuesday, July 20. Listen to the recording here.

How do I participate?

Hospitals need to track their experiences with Medicare Advantage plans from August 1 - 31, 2021. The information collected should allow the hospitals to calculate and answer the questions below. If your hospital plans to participate, please fill out this brief form by July 23, 2021, to let AMRPA know you will be participating.

What information do I need to collect?

AMRPA’s survey consists of the seven questions. Hospitals should track their authorization requests for the month of August in a manner that will allow them to tabulate and answer the following questions:

  1. How many Medicare Advantage patients did you request prior authorization to admit for ‎rehabilitation hospital care?‎
  2. How many of those requests were ultimately approved?
  3. For those cases that were approved, how long did it take on average for the MA plan to grant authorization from the time of initial request (in days and including weekends)?
  4. How many of your requests were ultimately denied?
  5. In those denied cases from question #4, how long did it take on average for the MA plan to issue its initial formal denial from the time of the initial request (in days and including weekends)?
  6. In how many cases, whether ultimately approved or denied, did the hospital, physician, patient (or family) need to engage in extra ‎effort to try to obtain authorization for admission? This could include requests from the ‎plan for additional documentation, needing to conduct a peer-to-peer discussion, filing a ‎formal appeal, or any other steps that were taken beyond the initial request for ‎authorization. ‎
  7. Of those requests requiring additional engagement from hospital, patient or ‎family (per question #6), how many were ultimately granted authorization? ‎

How should I track this information?

Hospitals are free to track this information in the way that is most convenient for them. AMRPA has developed a tracking tool for hospitals’ use, but hospitals will not be asked to submit this form.

What will I ultimately submit to AMRPA?

The only information that will need to be submitted to AMRPA is the numerical answer to each of the seven questions above, which will require calculating the answers using your data at the end of the month. We will also ask you to submit information about the location and size of your hospital or unit.

How will I submit this information to AMRPA?

AMRPA will provide an online survey at the end of the month for hospitals to easily submit their final figures.

Question #2 and #3 ask about requests that were approved. If a case was successfully appealed, how do we capture that?

In question #2, count any request that was ultimately approved, even if an appeal was required to receive an affirmative decision. In question #3, count how long it took from the time of the initial request until the affirmative appeal decision was provided.

Questions #4 and #5 ask about requests that were denied. If a case was unsuccessfully appealed, how do we capture that?

In question #4, count any case in which the patient was never granted authorization, including if the case was appealed unsuccessfully. However, in question #5, you should only count how long it took to receive the initial denial, not including the appeal time.

What if my hospital tracks authorizations differently or I want to track more detailed information than what AMRPA is requesting?

The survey was designed to allow for collection of standardized information by the maximum number of hospitals. We ask that, if necessary, you modify your tracking for the month of August to ensure you can submit answers to these questions. If you are tracking additional information about prior authorization and wish to share with AMRPA, we would be happy to receive it separately, but only as a supplement to the data requested from the survey questions.

If my hospital or system has multiple IRF locations, can I submit the data for multiple hospitals or units together?

Yes. Hospitals should feel free to submit information from multiple units or hospitals together. However, we ask that you indicate the total number of hospitals/units and beds included in the sample size for all locations when submitting your information.

Click here to participate in the MA Prior Authorization survey.