Practice Management

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  • 1.  Authorization Referral Question

    Posted 03-13-2018 10:39
    Good Morning,

             I am bringing an issue back to RBMA regarding issues with a referring physician getting authorization vs our imaging center getting the authorization.  There is a few plans that the PCP on file needs to obtain the authorization but I am hearing from other imaging centers in the same area as us that they have no issues obtaining authorization themselves vs the referring physian.  The only unique thing I can think of is that they are set up as an IDTF and we are not.  Same referring physicians that refer to us and also them, how is this so? I am not familiar with how an IDTF bills out.


    We currently bill out as a POS 11 and our primary taxonomy 193200000X Multi-Specialty Group 2085R0202X – Radiology Diagnostic Radiology then secondary is 2085R0204X – Radiology Vascular & Interventional Radiology.



    Any input is appreciated, thank you.





    ------------------------------
    Diane Ramirez
    Business Office Manager
    Radiology and Imaging of South Texas LLP
    Corpus Christi TX
    361-853-4503
    ------------------------------


  • 2.  RE: Authorization Referral Question

    Posted 03-13-2018 11:06
    I doubt that it has anything to do with how they bill.  Two possibilities come to mind:

    1.  They have made a deal with the health plan to allow them to obtain pre-auth.

    2.  When they obtain pre-auth, they are wording it in such a way that the plan thinks they are the PCP office.  I have seen some just lie and say that they are from the PCP office, and others that take a more nuanced approach and say they are calling on behalf of the PCP office.

    Perhaps you should reach out to the plans and ask what you need to do in order to provide the same service as the IDTFs.

    ------------------------------
    David Smith FACMPE
    Executive Director
    United Imaging Consultants
    Mission KS
    (785) 393-8387
    ------------------------------

    Original Message


  • 3.  RE: Authorization Referral Question

    Posted 03-13-2018 11:07
      |   view attached
    For those payers that require that the referring physician obtain the prior authorization, one wonders if the other imaging centers are being transparent and truthfully reporting to the payer that the request for the authorization is coming from imaging center staff and not the referring physician's office.

    See the attached OIG Advisory Opinion 12-10 for the requirements of the OIG for such pre-authorizations - in order to not be construed as remuneration to the referring physician to induce referrals - including transparency.

    ------------------------------
    Thomas Greeson JD, FRBMA
    Partner
    Reed Smith LLP
    Mc Lean VA
    (703) 641-4242
    ------------------------------

    Attachment(s)

    pdf
    OIG_Advisory_Op_12-10.pdf   123 KB 1 version
    Original Message


  • 4.  RE: Authorization Referral Question

    Posted 03-13-2018 11:34

    Thanks, Tom.

     

    Vicki R. Combs

    Business Office Manager

    The Radiology Clinic, LLC

    208 McFarland Circle, N   

    Tuscaloosa, AL 35406-1800

    D: 205-343-0903 Off: 205-345-7000

    F: 205-343-6700

    vcombs@tuscrad.com

     

    www.tuscaloosaradiology.com

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  • 5.  RE: Authorization Referral Question

    Posted 03-13-2018 11:41

    We are billing all payers, although in CT Anthem BCS and Aetna considered inclusive to the exam so we adjust it off.

     

    Donna

     

    Donna Russo, CPC |  Client Manager

    Direct 860-925-6482   |  cell 860-937-3033  | fax 860-925-6358 l main 860-688-0033

    1095 Day Hill Road; PO Box 101  |Windsor, CT  |  06095    

    Donna.Russo@M3Meridian.com  |  LinkedIn  |  Insights Blog

     

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  • 6.  RE: Authorization Referral Question

    Posted 03-13-2018 11:41

    We no longer own imaging centers, but when we did, we outsourced with a third party company that did pre-certs for the referring doctors.   The insurance companies allowed the third parties to work for both the radiology and referring doctors and we had no pushback.  Not need to tell white lies as those companies were there to serve in a non-partial way.  I believe that Athena Health offered that service, but it was three years ago.  The group felt it was worth it, as the pre-auths got done in a timely manner, we have hands off relationship with the process and it was cost effective vs hiring our staff.  We were forced to come up a solution as the competition was going the white lie route and blatantly offering the pre-auth service and referring docs can't help themselves from taking advantage of staff savings. 

     

    Darlene Molenaar, COO

    Colorado Imaging Associates, P.C.

    Healthcare Business Services, LLC

    1819 Denver West Drive

    Building 26; Suite 101

    Lakewood, CO 80401

    Office:  303-416-1360

    Cell:  860-989-6008

    Fax:  303-416-1058

     




    Original Message


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