No pre-auth, provider responsibility?

Messages
2
Best answers
0
Hello,

If pre auth is required and the office fails to obtain one is this the provider's responsibility? Are we allowed to charge the patient for anything, legally?

Thanks in advance!
 

sab001

Networker
Messages
41
Location
Pasadena/LaPorte Texas Chapter
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0
You could bill the patient; however, if you are an enrolled healthcare provider with the payor, you must follow the contractual terms of the agreement in addition to the guidelines set forth in the provider manual. Following adjudication, if denied for no authorization, you might be obligated to write off the billed amount and not bill the patient. If the practice develops a pattern of this, the provider could find him/herself being removed as an enrolled provider.
 

trarut

Expert
Messages
250
Location
Columbus, OH
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0
Your contract may allow for post-claim medical necessity review if precert is not obtained before the service. I'd check that out before writing off the service. Honestly, I'd appeal on medical necessity regardless of the contract!
 
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