Author Topic: Denial from UHC  (Read 2137 times)

Michelle1965

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Denial from UHC
« on: November 24, 2014, 05:12:21 AM »
Can you bill a patient if a claim is denied by UHC for the primary diagnosis code being an inappropriate diagnosis?  It doesn't seem fair to the provider, because if that is the reason the patient came in, and the provider treated the patient they should get paid for it. Can you make a patient sign an ABN for something like this?   Any reference material regarding this so I can educate the provider's and the staff would be greatly appreciated.  Thank you! :)

rdmoore2003

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Re: Denial from UHC
« Reply #1 on: November 24, 2014, 03:37:19 PM »
Can you be more specific on the "inappropriate diagnosis"?   I had this issue years ago.  Patient was female and had female issue.   Insurance had the patient listed as a male, therefore, claim was denied for inappropriate diagnosis.   
Do you have a contract with UHC?

As for an ABN, this must be signed prior to services. (If I am mistaking, please let me know on this)
Regina

Michelle1965

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Re: Denial from UHC
« Reply #2 on: November 24, 2014, 05:59:35 PM »
I work for an Ophthalmologist and the diagnosis is Keratitis 370.44 which was denied as the inappropriate one,but 377.43 for Optic Nerve Hypoplasia was also documented in the records as well, so now I'm wondering if I could just use that as a primary diagnosis?  I have been told yes and no.  I'm totally confused!  :o

kristin

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Re: Denial from UHC
« Reply #3 on: November 24, 2014, 08:22:33 PM »
An ABN can be signed, but it must be done before services are rendered. Can't do one after they are rendered.

As far as billing the patient goes, what does the EOB say for patient responsibility? If it says the charge is patient responsibility, you can bill them.

In regards to changing what was billed as the primary dx, you have to go with what the documentation says. If the reason the patient presented was keratitis, with a secondary dx/finding of Optic Nerve Hypoplasia, then that is how it is. You can't switch dx order because one will be paid, and the other won't.

shanbull

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Re: Denial from UHC
« Reply #4 on: November 25, 2014, 09:13:22 AM »
In regards to changing what was billed as the primary dx, you have to go with what the documentation says. If the reason the patient presented was keratitis, with a secondary dx/finding of Optic Nerve Hypoplasia, then that is how it is. You can't switch dx order because one will be paid, and the other won't.

Actually we've been told, in writing, to do this by a UHC subsidiary. Weird, I know.

kristin

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Re: Denial from UHC
« Reply #5 on: November 25, 2014, 07:24:25 PM »
That is weird...but if they allow that, then I would say go for it to the OP.