Advocacy & News

MA Prior Authorization Submission Form

Submit data by Friday, September 17, 2021.

Thank you for collecting data on Medicare Advantage prior authorization requests during the month of August. We are asking that all hospitals submit their compiled data no later than September 17, 2021. To do so, please answer the seven questions below, along with an optional eighth and ninth question if you are able. You will see that in order to answer the seven questions, you will need to calculate the figures using the data you collected.

If you have any questions about how to calculate and submit your data, please contact Jonathan Gold. However, please do not send your data directly to AMRPA via email, as we will be unable to tabulate data for providers. Thank you again for contributing your time to help advance AMRPA’s policy efforts with regard to prior authorization.

If plans or your state waived prior authorization due to COVID-19 or other reasons during the course of the survey collection, please do not include those patients for which there was never a prior authorization request made.

Click here for pre-survey information.
Your Name

First Name
Last Name
Your Organization
Your Title
Your Email
Your Phone
Area Code - Phone Number
‎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? ‎
8. In your experience, what do you think has most common reason Medicare Advantage plans use to ‎deny an authorization request? ‎Please only select one answer.
Patient does not meet Medicare criteria for IRF admission. ‎
Patient could be treated at lower level of care/intensity. ‎
Patient does not meet medical necessity criteria (generally). ‎
Patient does not require physician supervision. ‎
Patient does not require multiple therapy disciplines and/or intensive therapy. ‎
Patient cannot tolerate multiple therapy disciplines and/or intensive therapy.‎
9. Was prior authorization waived during the month of August by plans or your state due to COVID-‎‎19 or for any other reasons? Note: Any patients admitted under these circumstances without a ‎prior authorization request being made should not be included in your survey results. ‎
Yes
No
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Advocacy & News

MA Prior Authorization Submission Form

Submit data by Friday, September 17, 2021.

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