Pre-auth. for services
Randall McFarland, CPO
Description
Collection
Title:
Pre-auth. for services
Creator:
Randall McFarland, CPO
Text:
Hello List members,
One thing that frustrates me when trying to verify coverage, is when the
insurance company refuses to divulge how much they'll actually pay. Instead,
they say that the billing will be subject to review by the medical
committee AFTER we submit the invoice.(Which means AFTER we have already
provided our services)
In our attempt to be upfront, we prefer to forewarn our clients as to what
their anticipated financial responsibility will be so there will be no
surprises. This is impossible to do when we are expected to proceed without
any assurance (let alone guarantee) as to the benefits that will be covered
by the insurance company.
I recall hearing that Medicare has plans for a preauthorization hotline
of sorts and this will hopefully prevent many of the denials and reviews we
are experiencing while waiting to be paid for work we performed months prior.
In California, we also have the TAR system for Medicaid.
With other (non-contracted) pay sources, there is sometimes pressure on
us to proceed before it's totally clear what we'll be paid. As I have
learned to not to accept every discount a payor asks for, I'm starting to
realize that I shouldn't have to accept a policy of after the fact
decisions on our reimbursement.
I suppose that there will always be providers who will blindly accept
whatever the insurance company asks for (be it discounts or refusal to verify
benefits), so if I take a stand on an issue, they may just go down the road
to someone more desperate for work.
I have heard of memo billing or pre billing for services to
determine if (and how much) the insurance company will actually pay for
services. If this is a legitimate practice, is there a proper protocol that
should be followed? (I know this is not allowed for Medicare)
Do you agree that it should be LAW that ALL insurance companies/payors
be required to disclose their coverage to us BEFORE the invoice for services
rendered is submitted?
I will post responses. Please include your title and state, but put your name
in parentheses if you wish to remain anonymous.
Randy McFarland,CPO
Sunny Hills Orthopedic Services
Fullerton, California
One thing that frustrates me when trying to verify coverage, is when the
insurance company refuses to divulge how much they'll actually pay. Instead,
they say that the billing will be subject to review by the medical
committee AFTER we submit the invoice.(Which means AFTER we have already
provided our services)
In our attempt to be upfront, we prefer to forewarn our clients as to what
their anticipated financial responsibility will be so there will be no
surprises. This is impossible to do when we are expected to proceed without
any assurance (let alone guarantee) as to the benefits that will be covered
by the insurance company.
I recall hearing that Medicare has plans for a preauthorization hotline
of sorts and this will hopefully prevent many of the denials and reviews we
are experiencing while waiting to be paid for work we performed months prior.
In California, we also have the TAR system for Medicaid.
With other (non-contracted) pay sources, there is sometimes pressure on
us to proceed before it's totally clear what we'll be paid. As I have
learned to not to accept every discount a payor asks for, I'm starting to
realize that I shouldn't have to accept a policy of after the fact
decisions on our reimbursement.
I suppose that there will always be providers who will blindly accept
whatever the insurance company asks for (be it discounts or refusal to verify
benefits), so if I take a stand on an issue, they may just go down the road
to someone more desperate for work.
I have heard of memo billing or pre billing for services to
determine if (and how much) the insurance company will actually pay for
services. If this is a legitimate practice, is there a proper protocol that
should be followed? (I know this is not allowed for Medicare)
Do you agree that it should be LAW that ALL insurance companies/payors
be required to disclose their coverage to us BEFORE the invoice for services
rendered is submitted?
I will post responses. Please include your title and state, but put your name
in parentheses if you wish to remain anonymous.
Randy McFarland,CPO
Sunny Hills Orthopedic Services
Fullerton, California
Citation
Randall McFarland, CPO, “Pre-auth. for services,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 8, 2024, https://library.drfop.org/items/show/217155.
