Author Topic: ABN for remainder of partially approved services?  (Read 741 times)

dans169

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ABN for remainder of partially approved services?
« on: February 24, 2017, 07:32:15 AM »
Hello,
Question regarding doing an ABN when precertification for services is only partially approved.

The situation is we requested 16 units for neuropsych testing, interpretation, report prep and pt. feedback. Insurance only approved 8 units.

In the past, we would just see the patient and take the hit, but this has been coming up more often.

Can we have the pt. sign a separate agreement stating something to the effect that insurance has only approved x number of units of service, to do a comprehensive evaluation, we will need to collect x amount of additional funds in addition to what insurance has approved for payment?

I just don't want this to be misconstrued as "balance billing." Also, should we go ahead and submit the additional 8 units to insurance anyway knowing it will be denied?

The company in question is Magellan of IL. I researched their provider handbook and they do not mention the above situation, only that balance billing for network providers is prohibited.

Any input would be greatly appreciated.
Thank you!

Michele

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Re: ABN for remainder of partially approved services?
« Reply #1 on: February 24, 2017, 10:04:06 AM »
Have you tried appealing the fact that they only approved the 8 units?  Maybe that is standard and if you appeal with evidence as to why more units are needed they would be approved.

If that is not possible then I would contact Magellan to ask if the patient signs an ABN for the unapproved services, can they be balance billed.  You really need to find out what they say in order to not violate your contract with them.

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PsychBiller

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Re: ABN for remainder of partially approved services?
« Reply #2 on: March 09, 2017, 02:19:42 PM »

16 units seems pretty high for even the most extensive neuropsych battery; and time to score, interpret and write the report is not to be requested as additional hours.  Every insurance company has a specific amount of time that it is allowed for the administration of each test, and the scoring of it, interpretation and report writing is included (it is not a separate billable charge).

So, if you are administering a standard neuropsych battery of tests, 8 hours would be more than sufficient.  The patient feedback session would be billed separately, and would not be billed as part of the testing hours.

If Magellan in IL is a medicaid program, it is unlikely that they will allow additional hours, or allow you to bill the patient the remaining hours.

Michele

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Re: ABN for remainder of partially approved services?
« Reply #3 on: March 10, 2017, 12:07:30 PM »

16 units seems pretty high for even the most extensive neuropsych battery; and time to score, interpret and write the report is not to be requested as additional hours.  Every insurance company has a specific amount of time that it is allowed for the administration of each test, and the scoring of it, interpretation and report writing is included (it is not a separate billable charge).

So, if you are administering a standard neuropsych battery of tests, 8 hours would be more than sufficient.  The patient feedback session would be billed separately, and would not be billed as part of the testing hours.

If Magellan in IL is a medicaid program, it is unlikely that they will allow additional hours, or allow you to bill the patient the remaining hours.

I actually didn't think about that.  We also bill for a dr who does testing.  He also usually bills 8 hours, sometimes less, never more.
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