Clarifying Billing Private insurance before "Date of Delivery"

Clarifying Billing Private insurance before "Date of Delivery"

Andreena Pulak

8/28/2012

Let me clarify on my email before, I am more in referencing on private
insurances not government sponsored insurances. So a ABN will not help
in this situation. When we see patient and we conclude what the patient
will be billed for, we always call the insurance and get a Pre-Auth for
the Lcodes that will be billed. Most PRIVATE insurances will say no
Pre-Auth is needed,and the codes are covered and we get a reference
number for the call and then order the parts for the patient and go on
with the process.(There has been times where they say the codes aren't
covered even when we have a Pre-Auth, but we fight these claims) The
patient receives the orthosis, or prosthesis and we bill the insurance
with the date of service being the date of delivery. Then we wait for
the payment from the private insurance and this has happened two times
before the insurance sends us a EOB stating that the codes are not
covered, for some reason they give. We want to avoid this again, so I
want to know, if we can bill the insurance before we deliver the product
to the patient. if we can, can we bill with the date of service being on
the date of eval, or date date of final fitting, or date of trial( we go
this route if we cant go the other routes) instead of billing on the
date of delivery(as this is our normal protocol). With Medicare audit in
the air, we want to make sure everything is by compliance, but in all we
want to make sure we can get paid for the services and products
provided.



Any suggestions will help


Thank you,


Andreena Pulak
Billing Personnel