Author Topic: Residential treatment - need advice  (Read 1597 times)

adiesp1

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Residential treatment - need advice
« on: December 08, 2011, 12:36:11 PM »
I have a new client with a bit of an old mess.  They have patients that, during a staff transitional period, they did not obtain pre-auths on (under previous billing company).  They have been trying to get it authorized after the fact, but that is not working for them (patients have been discharged).  The claims will be denied.  Do you think there is any hope of an appeal working?  Any suggestions so these are not a lost cause for them?  Of note, they are not participating with insurance carriers.

Thanks for any thoughts,
Adrienne

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Re: Residential treatment - need advice
« Reply #1 on: December 08, 2011, 01:33:01 PM »
I always say, "It can't hurt to try".  Do an overall appeal letter to each carrier with reference to each claim, explain the staffing transition and ask them to please consider payment.  You have a 50/50 shot with some claims depending on how old.. if it's over a year, you can still try but I wouldn't hold your breath. There is a small silver lining. In most circumstances the provider can write those losses off, have him speak with his accountant.
Linda Walker
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Michele

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Re: Residential treatment - need advice
« Reply #2 on: December 08, 2011, 07:51:23 PM »
I would have suggested exactly what Linda did.   8)  It's always worth the try, but it really depends on not only the carrier, but the person whose desk the appeal lands on.  50/50 is what I would have said.
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adiesp1

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Re: Residential treatment - need advice
« Reply #3 on: December 09, 2011, 09:46:13 AM »
Thank you both.  I will give it a try and hope for the best.
Adrienne

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Re: Residential treatment - need advice
« Reply #4 on: December 09, 2011, 01:15:49 PM »
I can only speak from carriers I worked for, examiners were given certain administrative decision making and timely filing limitation overrides were one of them.. however when dealing with case management or authorizations those couldn't be over-ridden unless the case management team back dated the auth and for most examiners this wasn't worth the hassle.  Certainly I would take the time to at least run it past case management if I were to receive a letter requesting consideration for something like this situation, but I would try and put all the claims in one appeal, make sure they are grouped and organized this way you make their life a little easier and that makes for a better shot for you :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com