How does pre-authorization work happen in LTAC transfers? Medicare vs. non-Medicare patients

  • Transfer pre-authorization
    • pre-authorization not needed for Medicare patients
    • Most insurance companies have contracts with LTAC facilities, and these transfers do not need pre-auth
    • Only transfers to non-contracted facilities may need pre-authorization
  • Medication pre-authorization
    • Medicare patients - since LTAC falls under Medicare Part A, there is no-need for pre-authorizations. Medication treatments are covered under PDPM rules. Note: if the transfer is not to LTAC. but for assisted living, then medications may fall under Medicare part D, and pre-auth may be necessary.
    • Non-medicare patients - private insurance rules vary, pre-authorization may be needed. Sending the coverage information is therefore important, and a clean medication list is critical,
  • Based on the above, communicating pre-authorization numbers as part of the request and transfer process is not considered of immediate importance

Initial dates for testing sessions:

  • October 17 (and if needed, use the regular call time on the 18th)
  • November 5th and November 7th
  • No labels