Author Topic: Inpatient visit denial for auth  (Read 1342 times)

Cpatel

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Inpatient visit denial for auth
« on: October 18, 2012, 07:18:12 AM »
I am doing billing for a practice who give inpatient visits in hospital. I am getting hard time to get paid denied claim for auth. In patient services 100% depend on hospital auth but some times hospital staff do not take proper authorization or do not submit claims to correct insurance within time frame. In this case claims for my docs are denying for either missing auth or missing admission info from hospital. So I do appeal the insurance with Medical notes but they still denies the appeal.

Do any one else have this issue? How to overcome these denials?

PMRNC

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Re: Inpatient visit denial for auth
« Reply #1 on: October 18, 2012, 04:14:30 PM »
Good news ..  You can attempt the appeal but if denied again the patient is responsible. The reason is that authorizations (unless in an emergency) are up to the patient and needed within usually 48 hours of admission.  Another thing you can check is if there was an authorization for the actual hospital stay and sometimes that is good enough, but you have to get this off the patient face sheet from the hospital.   Ultimately the patient is responsible for obtaining proper authorizations. Many times the hospital administrative staff does this as it's in their own best interest to do so. If this was for an emergency you can appeal on that basis.   Another tip is that the patient has better chance of an appeal than the provider on these types of appeals.. they are more sympathetic to the patient who calls and says.. "Listen I was sick, I didn't know I had to call or I forgot, etc etc"  It's a 50/50 shot :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Cpatel

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Re: Inpatient visit denial for auth
« Reply #2 on: October 22, 2012, 11:53:23 AM »
Thanks. In my case  after denial for auth before I take any action I call hospital and find out if they are paid. If hospital has accepted denial and if they are not taking action then I should bill to patient. This is right? Some times hospital w/o the amount or cover the expense from charity. What should I do in this case?

PMRNC

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Re: Inpatient visit denial for auth
« Reply #3 on: October 22, 2012, 03:33:23 PM »
Quote
If hospital has accepted denial and if they are not taking action then I should bill to patient. This is right? Some times hospital w/o the amount or cover the expense from charity. What should I do in this case?

This shouldn't have anything to do with your services. Your provider provided services and if the hospital wrote off their charges, it has nothing to do with your services. you still have a right to get paid.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com