Author Topic: Can you bill patient when insurance denies inpatient auth  (Read 2463 times)

cwagner

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Can you bill patient when insurance denies inpatient auth
« on: March 02, 2012, 01:32:14 PM »
I work for a private physician group. We provide consultation services to the local hospitals and bill our services through our private practice.

We often get denials from carriers as not medically necessary. When the hospitals exhaust all appeals and the denials are upheld can we as a private practice bill the member?

How do other practices handle this?

Thank you!

PMRNC

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Re: Can you bill patient when insurance denies inpatient auth
« Reply #1 on: March 03, 2012, 08:28:37 AM »
Quote
I work for a private physician group. We provide consultation services to the local hospitals and bill our services through our private practice.

We often get denials from carriers as not medically necessary. When the hospitals exhaust all appeals and the denials are upheld can we as a private practice bill the member?

How do other practices handle this?

If you are billing out your professional charges, why is the hospital appealing? Are they appealing their fees? Are your claims that come back to your office for your services, being denied? If so, then I say, yes you can bill the patient. They will be aware of the denial from the EOB from their carrier as well.   
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

cwagner

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Re: Can you bill patient when insurance denies inpatient auth
« Reply #2 on: March 05, 2012, 04:19:44 PM »
The hospital's inpatient auth was denied for not medically necessary.  They have appealed numerous times to no avail and will not continue to appeal.  Because the hospital auth was denied and their claims were not paid the carrier is denying our professional services as not medically necessary as well.

PMRNC

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Re: Can you bill patient when insurance denies inpatient auth
« Reply #3 on: March 05, 2012, 04:59:20 PM »
Ok, so basically the patient is required to get an impatient stay authorized, and usually they give 48-72 hours to do that.... correct? Hospital appealed, denied and your services are also being denied since they were within that inpatient time period..   I'd say you can try and appeal the professional charges, sending in a letter with something that may have been missed as to why there was no authorization done and hope for best. Otherwise, this is a patient requirement so you can and should bill the balance to the patient. Sometimes patient's have a better chance of an appeal in this situation.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

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Re: Can you bill patient when insurance denies inpatient auth
« Reply #4 on: March 05, 2012, 05:01:30 PM »
And the patient will have signed intake forms taking responsibility for charges not paid by their insurance company.  Their contract is with their insurance company.  You billed in good faith.  If the charges are denied, you can bill the patient.