by AJ Riviezzo
There are other elements outside of charting that the practice should review.
Authorizations – It is, obviously, important to obtain an authorization when required. Most everyone does that fairly well. There are two less noticeable issues that seem to add chaos to the process though. The first is number of units. It is not uncommon to see a denial for the third ablation because only two units of the ablation were requested. If the treatment plan changes, you can re-open the authorization by contacting them to include the newly desired third ablation. I lieu of this, you can request a new authorization for the additional treatment.
The second sort of sneaky way we see authorization denials is due to the procedure falling outside of the window of time granted in the authorization. Most authorizations allow services to be conducted within a certain amount of time. If, for whatever reason, a procedure is going to fall outside of that window, it is usually quite easy to have the time extended. It is just that many practices fail to take this issue into consideration. Read the approval letter carefully and note the date range allotted, we even occasionally see all treatments approved but for only one day. While obviously an error on the part of the auth department, it is far easier to correct before treatment is performed.
Almost every authorization process will notify you that an authorization is not a guarantee of payment. It is also not a guarantee that medical records will not be requested. Yes, you likely already sent the History and Physical and the Diagnostic Ultrasound, but the payer can still delay claim payment by requesting a copy of these documents along with a copy of the ablation report. The payers do not keep a file by provider and by patient and retain these documents. It is by claim.
ABN’s – Advanced Beneficiary Notifications – An ABN must be obtained any time you are doing non-covered services for or selling something like stockings to a Medicare beneficiary. You should obtain an ABN each time you provide these services. A good example would be cosmetic sclerotherapy. This is a non-covered, cash pay service. The patient may come in three times for this service. There should be three ABN’s on file. We have seen practices get a bit caught on this. One practice has a very creative patient who filed their own claim to Medicare for cosmetic sclerotherapy. Medicare asked the practice for a copy of the ABN noting it was a non-covered service. When the practice could not produce the requested ABN, they were forced to refund the patient. Patient Monies – Everyone has a different process for collecting or not collecting these monies. Just know if these are not collected up front, before services are rendered, your ability to collect diminishes greatly if you wait until after the treatment is completed. I know when I see my PCP or non-vein specialist the first thing they do is collect my copay. Why vein practices are reticent about this is still a bit of a mystery to me.