StephanieRay
New
Hello all,
One of our clients is a larged hospital based radiology practice in Virginia. We've recently noticed a trend and to make a long story short(er), the professional readings for advanced imaging studies (MRI, CT, etc.) are being denied for no pre-auth by VA Medicaid, when billed with an outpatient place of service for a patient who is in an Observation stay at the hospital. These physicians rely on the hospital for demographic information and authorization services, etc. The hospital is not obtaining an authorization as their DRG billing will show "Observation" and VA Medicaid does not require an auth for these services in an Observation setting. Professional providers do not have an "observation" place of service to bill with therefore, we use outpatient (when we can't use emergency room, of course). My staff and I have been round and round with Medicaid and KePro to no avail. Has anyone else out there encountered this specific situation and if so, can you offer any advice?
Thanks ~ Stephanie
One of our clients is a larged hospital based radiology practice in Virginia. We've recently noticed a trend and to make a long story short(er), the professional readings for advanced imaging studies (MRI, CT, etc.) are being denied for no pre-auth by VA Medicaid, when billed with an outpatient place of service for a patient who is in an Observation stay at the hospital. These physicians rely on the hospital for demographic information and authorization services, etc. The hospital is not obtaining an authorization as their DRG billing will show "Observation" and VA Medicaid does not require an auth for these services in an Observation setting. Professional providers do not have an "observation" place of service to bill with therefore, we use outpatient (when we can't use emergency room, of course). My staff and I have been round and round with Medicaid and KePro to no avail. Has anyone else out there encountered this specific situation and if so, can you offer any advice?
Thanks ~ Stephanie