Physician Authorization for Inpatient/Observation Services

alwyzjazzephae

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How does everyone go about getting authorization for their physicians for inpatient and observation hospital services that they perform during rounds? Currently we are having to write off a lot of our hospital claims for not having authorization. I am having a hard time figuring out the easiest way, for both our doctors and staff, to try and get authorization!
 

cathi0811

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Does the hospital that your physicians doing rounds at, not get the authorization for the pt stay during admission? Our office has had this happen to us previously and we had to appeal our claims with the hospital authorization #, as this should have been covered under a umbrella auth for all "on call" or consults requested by the admitting physician. Hope that helps
 

CodingKing

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Insurance company wont accept a PA request from a physician for a hospital admission. Id get on the hospital ASAP as they are responsible for obtaining the auth.

At least the insurance company I work for, we do not require facility auth on file for the physician component of inpatient or observation to pay. Our biggest issue is the hospital admitting patients when they really only met criteria for Observation level. Then once the Physician claim comes in the place of service code doesn't match the authorization and it rejects.
 

sew1984

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I work for a very large physician practice in Georgia that has privileges to treat/admit patients at two major area hospitals. When we initiate an admission, or plan a surgery for a patient, whether that be inpatient or outpatient, it is always our responsibility to obtain authorization (since we planned the course of treatment).

If a patient presents to the Emergency Department and is admitted by our physician through the ER, it is still the responsibility of that hospital to obtain authorization since they presented (unplanned) to the ER.

If another physician has admitted a patient and we happen to see that patient during the admission (perhaps we consult, perhaps we do a surgery, and continue seeing them until they are discharged), it is not our responsibility to obtain authorization, since our services should be covered under the "umbrella" of the authorization that is on file for that entire admission.

All of our insurance payors recognize these guidelines. Best of luck to you!
 

alwyzjazzephae

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Forgive my lack of knowledge! I'm more familiar with coding, and just now starting to get into working some denials!

What about insurances that do not require authorization for the hospital, but some of the physician services still require auth? United health care denies just about ALL of our observation services because the hospital did not need to obtain auth, so there is not authorization on file. Also, what can we do when they state the authorization has been exceeded? Any procedures or admissions our doctors initiate, we do not have any issues.
 
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