ccallycat
Networker
I work for a practice that is on call for cardio-thoracic in 4 hospitals, so we see older patients, and I have a few that have Medicare part A only as primary then secondary is a commercial insurance. The hospital only cares about getting auth for primary, which is not needed and then the secondary will follow. (These patients have never seen us before, this is not a planned admission, they always arrive through the ER and are admitted and we are asked to consult/treat after admission). However for provider services, I cannot bill Medicare, because their part b is inactive, so I must bill the secondary as primary. The secondary insurance will deny us because there is no auth on file. I have sent in reconsiderations and appeals stating mcr part a prime, so hsp did not auth secondary, and we were asked by hsp to consult/treat, medical necessity, and since Medicare is primary, they did not get one from the secondary, and that the patient who went through the ER shouldn't be held responsible. Denial is upheld and pt is left responsible.
I just got another one of those denials, however, the hospital did notify secondary insurance, Aetna, they got an auth number so I thought we were good, but I just spoke to the rep. and that auth number was only good for one day, and they denied the auth for inpatient. Hsp probably doesnt care cause they get paid by medicare. I know I should start the reconsideration and appeal process, which I will, but I know they will deny me again. Has anyone had any success on getting these types of denials paid? I thought about submitting to Medicare just to get denial to attach to secondary claim to see how the secondary will handle it.
I know my next step is to get the patient involved and have them appeal (we are oon provider so my hands are tied after a certain point), however this patient in particular is in a rehab/nursing home.
I just got another one of those denials, however, the hospital did notify secondary insurance, Aetna, they got an auth number so I thought we were good, but I just spoke to the rep. and that auth number was only good for one day, and they denied the auth for inpatient. Hsp probably doesnt care cause they get paid by medicare. I know I should start the reconsideration and appeal process, which I will, but I know they will deny me again. Has anyone had any success on getting these types of denials paid? I thought about submitting to Medicare just to get denial to attach to secondary claim to see how the secondary will handle it.
I know my next step is to get the patient involved and have them appeal (we are oon provider so my hands are tied after a certain point), however this patient in particular is in a rehab/nursing home.