Appointment of Representative, (aka the AOR) always seems to be a topic of conversation in the healthcare payer space. Every show we attend, every customer we talk with and every industry function we attend, there are intense conversations and differing opinions on what is required by CMS. Do you only submit an AOR once? Do you need to submit a new AOR each time? Can a photo copy be used if it’s within a year of the original? Lots of questions, but no one ever seems to have a definitive answer. Most healthcare payers will default to having an AOR submitted each time to make sure they are in compliance with CMS.
However, there may be light at the end of the tunnel. In the new guidance consolidation of Medicare Advantage Chapters 13 and 18, CMS is giving us a clearer understanding of what is required. In Section 20.2 of the new guidance CMS states “If the representative form is maintained and accessible by the plan, a photocopy of the signed representative form is not required to be filed with future grievances, coverage requests, or appeals made on behalf of the enrollee in order to continue representation. If the plan uses a representative form that is on file for requests, it must include a copy when sending a case file to higher level adjudicators, if applicable.” They also state that the representative form is valid for one year from the date it is signed by both the enrollee and the appointee, unless revoked.
So there you have it and it’s crystal clear! As long as the plan maintains the signed AOR and it can be accessed and available for review when future requests come in, then we have fulfilled CMS requirements. Hopefully if this new guidance plays out it can make the AOR process a smoother one for all involved. CLICK HERE to review the guidance document.
The most recent social media trend has been the 10-year challenge, when an individual posts a picture on a social media platform like Facebook, Instagram, Snapchat or Twitter, and compares a picture of themselves from 2009 to 2019. Which typically sparks a conversation between followers and friends of how so much has changed within the 10-year time span. 2009 to today has […]
Greetings and welcome to 2019! As you begin planning your new year and accomplishing goals, we wanted to share with you some upcoming healthcare related conferences we will be supporting in February, March and April. First we’re looking forward to getting out of the Cleveland winter and heading to at HIMSS19 in Orlando, Florida. Seema Verma and Alex Azar will […]
Appointment of Representative, (aka the AOR) always seems to be a topic of conversation in the healthcare payer space. Every show we attend, every customer we talk with and every industry function we attend, there are intense conversations and differing opinions on what is required by CMS. Do you only submit an AOR once? Do you need to submit a […]
As part of an initiative to streamline the Medicare Advantage and Prescription Drug appeals and grievance processes, CMS has consolidated Chapter 13 of the Medicare Managed Care Manual and Chapter 18 of the Prescription Drug Benefit Manual into one comprehensive guidance document. They are doing this to better align and provider a more defined, straightforward and non-repetitive understanding of […]