Medical Billing Forum
Payments => Patient Billing => : rdmoore2003 March 30, 2012, 01:52:35 PM
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When an insurance company gives a partial authorization for services and they require us to notify the patient that the charges not authorized can be billed to patient if patient is given this information and amounts prior to the service. My question is, is there a general form that I can find that documents this information or is it just something I need to come with. For example, we request 4 units of psych testing. We get auth for 3 units and if we bill patient for the remaining 1 unit. We have to get this in writing prior to the service. Is there a general form?
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Could you make up a form similar to the Medicare ABN? Their verbage is clear and concise.
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I could....thanks....its Friday, and my brain usually cuts off by now....
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Don't forget that you have to look at each carriers contract to determine IF you can bill the patient, some contracts do not allow you to bill patient for services not authorized beyond what they authorize.
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Yeah, my brain just cut out too! And it's only 9:20 AM and I gotta work til 5............Good thing I'm not a brain surgeon!
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What do you mean your not a brain surgeon?? come on now!
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yes thank you. Linda, what are your thoughts with Valueoptions? Do you have issues with them precerting requested psych testing?
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I used to do a lot of Value Options, but now it's dropped off significantly. We do have to get authorizations for psych testing and they will only authorize one on a day w/no therapy.
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Linda, the issue we are having with Valueoptions is if we request say 3 units of testing, they never give us that. Even with their list of testing, our units are mostly equal to their units per test and we still don't get the total hours requested. To appeal, we have to contact them, wait for them to send a form to us in the mail, then the patient has to come to the office to sign, then we have to mail it back to them just to start the process. Does this sound familiar?
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Hmm, I don't have an issue because the provider does them on different days for that reason. They will only authorize one unit per test per day. We have a few other carriers that do same thing which is why it's just better to give them diff appts. The good thing is that breaking it out doesn't mean it will go towards the MH maximum as long as your just doing testing that day. I went back and looked and right now currently I only have ONE active Value Option case and we did testing about 7 months ago.. 3 different dates and the authorizations are different. (3 authorizations). Everything was paid.
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ok thanks