Medical Billing Forum

General Category => General Questions => Topic started by: Christin B on January 18, 2011, 10:18:41 PM

Title: Urgent Care-MRI-Authorization
Post by: Christin B on January 18, 2011, 10:18:41 PM
I am hoping that someone here can help me with my problem/question.  We are a large medical group and we have two urgent care centers which we bill with the urgent care place of service. 
Here is my scenario:
The patient is treated and the doctor orders an MRI or CT scan.  The "Urgent Care" is located in a building which also has other doctor offices’ and X-ray/MRI equipment. 
We submit a claim for the visit using place of service 20 and the visit gets paid.
The treating physician orders an MRI and the patient goes down the hall to have that done.  We send in a claim for the MRI and the place of service is 11.
The claims for the MRI get denied for no authorization. 
An auth is not required if it is part of the Urgent Care visit.  However, since we are using two different places of service codes the insurance company does not recognize that the MRI is related to the Urgent Care claim.  We also use the same tax id number.
What we do now is this:  If the MRI gets denied, which it always does for no auth, we appeal to the insurance company with records, etc... That it was part of an Urgent Care visit, and maybe it will get paid on first time appeal submission.  However, it sometimes takes up to one year for them to finally pay.
A large insurance carrier in the state of California told us to bill with the Urgent Care place of service for the MRI.  We can't (for whatever reason).  So, now instead of us appealing which worked but like I said, it could take a year, they said since you are billing with the place of service 11, you do need an auth regardless if it is in conjunction with the Urgent Care visit.
Is this some credentialing thing
I hope what I wrote makes sense.  I have tried to get a straight answer at work, but it gets dismissed like this is how it is so, deal with it.  I just need to know why.   
Thank you for any help you can provide

christin
   
Title: Re: Urgent Care-MRI-Authorization
Post by: PMRNC on January 19, 2011, 07:47:27 AM
Quote
A large insurance carrier in the state of California told us to bill with the Urgent Care place of service for the MRI.  We can't (for whatever reason).

I think this is where you have to start, it sounds like you probably have some sort of facility licensing/credentialing problem. If it is POS 11 it is going to be denied.
I would look into the issue with the facility.
Title: Re: Urgent Care-MRI-Authorization
Post by: craig.caudell on August 23, 2012, 12:46:55 AM
Well i think the main issue is that you have different departments as one is Urgent Care as well as other is MRI & Scanning. First of you can request your insurance company to give different certifications for your both of the departments. 1 year is such a long time, You can request them to take some steps ASAP.