Just a reminder to all of you California ASH providers that the most wonderful time of the year is upon us….threshold time! You should have recently received a letter about your tier status, hopefully you went up or at least didn’t go down….To recap what this means, most of you are at a 5 visit threshold. If your tier status increased, you may be at 8 now or even better 12 or the elusive unlimited (never need authorization). It can take a very long time to move up in tier status and you all start out with 5.
If you are a terrible documenter, you can be dropped down to needing an authorization for each and every visit, so it does get worse than 5. What all of this means is that each July 1, you can see a patient for this amount of visits without needing authorization. If you see Kaiser patients, they do not fall under this luxury time, nor do patients 12 years old and under, but all others qualify. If you had gotten an authorization prior to this time but it spans July, so for example in June you got an auth for 6/15-7/15, then your threshold begins AFTER 7/15. If, however, you request an authorization after 7/1, you FORFEIT your threshold and must now abide by the authorization time frames (requesting authorization during the threshold time supercedes it and says to ASH, no thank you, I do not want my threshold visits I would much rather do paperwork). Remember too that the threshold time has nothing to do with the patient’s annual visits, they still apply. This is what I always find confusing. In January, the patient’s benefits start over, maybe they get 20 visits per calendar year for example, but the threshold starts over every July. Make sure to keep track of visits used on an annual basis but remember to take advantage of this wonderful threshold time, it’s the only paperwork breather you get from ASH. One last note, your threshold applies to you the provider. If a patient saw a different provider before you, they had their threshold and now that the patient is coming to see you, you have your threshold. It isn’t a combined thing among providers, you each get your own special ASH time.