obser. coding

bellsmom

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need help: my practice sees patients that are in observation in the hosp. we r coding office levels because we are not the admitting doctor.

this only is a problem with KEYSTONE HEALTH PLAN EAST.

They are denying the claims because no referral is on file. We can not get a referral due to the POS is the hospital.

Need to know if anyone else is having this problem and how are you getting your claims paid. My boss is really needing a answer please get back to me ASAP. thanks
 

penguins11

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You should be able to appeal these and get paid by sending a claim inquiry by stating that the service was performed in the hospital so you couldnt get a referral because it was an emergency.
 
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