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afeaster72

afeaster72

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I have an insurance company that keeps denying my claims for exceeding the APC rate. We are an ambulatory surgical center, the codes I am billing have a payment indicator of A2. We are performing cataract extractions & laser (yag). This is the ONLY insurance company giving me this issue and I am having NO luck with my rep. Can anyone help me with this? I am so lost.
Thanks so much!
Alex
 
I responded to you on this when you posted the question a couple weeks ago. Sorry you're still having trouble. If your entire claim is being denied for this reason, then I don't think you have any choice but to keep trying to get through to the correct person at the payer who can help you resolve the problem. If it's only a partial denial, then that might just be an adjustment that needs to be posted. Without seeing the claims and knowing more of the details, it's hard to advise you on this.

If your network representative isn't responsive, you may need to try other routes to escalate the issue. Get the provider or practice manager involved. If the insurance company won't cooperate, then tell your patients with that insurance that you can't schedule them for procedures because their insurance company won't work with you - often when a patient gets involved, the insurance company will become more motivated. As a last resort, have your provider send notice that you are terminating the contract. I think you said this was Amerigroup, correct? I faced a similar problem with them many years ago - their network was simply not adequately staffed to deal with provider issues and we could not even get a call back. But when we gave them notice that we were going to terminate the contract, the phone range the very next day and they took care of the problem. It's sad that it has to come to that, but your providers are running a business, and if your customers aren't paying their bills, then you just have to consider not accepting those particular customers any longer.
 
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