Wiki Cardio with UHC for echos precert outpatient

[Kclose1975@yahoo.com]

Has anyone had to deal with this for physican services need to be precerted for outpatient? I think this is setting us up to fail on getting auths for payments. When the bills obs we are billing out patient for the physician billing, therefore if we do not get auth we will deny. I don't understand how this is possible to do when you aren't getting the docs charges until AFTER services have been renedered. Anyone have suggestions on how they handle these?

 

[bmx1616]

I believe UHC gives you two weeks from the date of service to have the authorization.

 

[beckyperrone]

The new guidelines that start on 7/1 appear to state that you cannot even schedule the patient for an outpatient echo until the auth is obtained. I agree--they are hoping you don't get it first and they can then deny. I was not aware of the two week grace period. As it is now, we have to call to get them when the docs want to do echo on the day of the visit. If pt has had an echo in the last two years, I always have to call--it never gets ok'd online.

 

[bmx1616]

Maybe it's different for the echo's , I know we have the two week grace period for cath's