June 28th 
1:30 to 3:30 pm EST

Allegheny County Medical Society
 713 Ridge Avenue
Pittsburgh, PA 15212

 

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Register to Attend

 

On January 1, 2019 the act of balancing healthcare access and cost became more complex.  Highmark announced a number of new procedures which require providers to obtain prior authorization to perform. Healthcare providers have expressed concern that burdensome prior-authorizations for routine procedures will create new delays for patients to receive care and force more care into higher cost settings.

On June 28th Highmark will present on the performance of prior authorizations for CPT 93306 – TTE “rest” echo complete Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

 

The meeting will be held June 28th from 1:30 to 3:30pm EST. An in-person meeting will be hosted at the Allegheny County Medical Society at 713 Ridge Avenue, Pittsburgh, PA 15212 and a teleconference will also be made available.

 

The purpose is to evaluate the performance of their prior authorizations, now with several months of data.  Key questions to be addressed include

 

  • How many levels of escalation were involved and what was time frame of the process until a final decision on the authorization request was reached?
  • What was reason for denial ?
  • What was patient outcome?
  • Echos  performed without authorization, how was payment handled?  If not paid – was the full amount billed to the patient?
  • The percentage of all approvals including after appeal and peer-to-peer discussions.
  • Has this program around Echos shown high utilization or inappropriate use savings and if so, how much?
  • Can Highmark and Evicore address criteria for "goldcarding" and  providing data feedback? How many echoes are orders by cardiologists versus not cardiologists
  • Want percentage are repeat echo studies? Could Highmark list the indication for repeat echo studies and the date the last echo was done?