I am hoping that someone can tell me how they are dealing with this problem.
We have been told by Network, UHC and Anthem that we can not use an ABN for their Medicare patients before a service is rendered without first getting a "predetermination". We are a Family Practice office in Wisconsin, and we do a bit of everything, which makes this extra difficult to implement.
The predetermination is supposed to be for anything we feel may not be covered. Then if the insurance says "no, we won't cover it", we can have the patient sign a form saying they will be responsible for the payment.
Each different Medicare plan within each insurance company is different, so it is almost impossible to know who covers what, and for which diagnosis.
If we know something won't be covered- then they say we don't need a predetermination, or a signature, and the patient would be liable. I feel this scenario is an open pit waiting for us to fall in to it.
Our biggest problems seem to be figuring out how to make this do-able for the staff without tying up much of their time, the gray area of what we "feel" might not be covered, and not having to write off services. Is anyone else having this problem?
We have been told by Network, UHC and Anthem that we can not use an ABN for their Medicare patients before a service is rendered without first getting a "predetermination". We are a Family Practice office in Wisconsin, and we do a bit of everything, which makes this extra difficult to implement.
The predetermination is supposed to be for anything we feel may not be covered. Then if the insurance says "no, we won't cover it", we can have the patient sign a form saying they will be responsible for the payment.
Each different Medicare plan within each insurance company is different, so it is almost impossible to know who covers what, and for which diagnosis.
If we know something won't be covered- then they say we don't need a predetermination, or a signature, and the patient would be liable. I feel this scenario is an open pit waiting for us to fall in to it.
Our biggest problems seem to be figuring out how to make this do-able for the staff without tying up much of their time, the gray area of what we "feel" might not be covered, and not having to write off services. Is anyone else having this problem?