ANFinch92

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Location
Rosamond, CA
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Hello Everyone,

My administrator has asked me to verify payment of a Lucentis Injection for a patient who has a MediCal HMO. The facility has an authorization for the procedure, which includes the J2778, as well as the 67028. The IPA for the HMO is stating as long as I have the approval, it will be paid, as long as it is within medical necessity. Is there anything else I can do to ease my administrator and her worries?

Thank you!
 

Cheezum51

Expert
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367
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Make sure the provider properly documents the medical necessity of the injection. I've reviewed some notes from retinal specialists where they just document the injection procedure itself and not the findings/diagnosis which necessitated the need for the injection.

Proper documentation, along with the HMO's authorization for the visit and the materials should be enough to get payment.

Tom Cheezum, O.D., CPC
 
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