I am unable to locate any kind of information for this prior authorization problem I am having. We have an orthopedic clinic that refuses to get a prior authorization on procedures they perform on patients at an inpatient facility. They state that these procedures are emergent/urgent and they cannot obtain prior authorization and that they are allowed to use the prior authorization obtained by the facility. Even when we appeal we are denied, we are appealing as this: "It is the responsibility of the admitty facility, admitting or attending physician, surgeon, and/or primary provider of service to obtain the required authorization. Certain medical services performed by professional providers are an integral but separate adjunct component of an authorized or covered medical service. Separate adjunct medical services performed by a healthcare professional, when performed in combination with a covered inpatient admission, surgial procedure or other medical service are to be considered for reimbursement regardless of the presence of an authorization." I think I read somewhere that the surgeons are covered under the "umbrella" of the inpatient authorization. Does anyone have any kind of documentation or website or any help that they can provide to get this straighted out? Thank you!


Jennifer Pederson, CPC
Lincoln, NE