Practice Management

I know this matter was being evaluated by the RBMA a few years ago and I wondered if it is still being pursued.  We continue getting preauth/CO denials for advanced imaging studies performed on patients who are in Observation.  From what I understand, our hospitals are not generally getting these denials, hence there is little concern on their part to address the issue.

I would love to hear the experience of others, especially any success you might be having in navigating this very frustrating situation. 

When you add this to the coordination of benefits denials, the requests for additional information from the patient denials, the QMB issues between Medicare and Medicaid, it makes for a ridiculous amount of work.  (Just a little venting on a Friday afternoon).

Thanks to all for serving as such a great resource!

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Sheila Witous, MBA, CPA, CGMA
Chief Administrative Officer
Radiology, Inc.
South Bend IN
(574) 258-1100 ext. 205
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Sheila its good to vent on a Friday.
how about payors denying DBT all of a sudden, bundling doppler and US, a payor after 20+ years telling us we are using the wrong POS code.
Just never stops.

relative to auths:
1. some of our contracts we had it written they could not deny for this in the facility setting, we have no control over the auth process.
2. some I would show them the information i had from the hospital wherein they were paid and we weren't.  usually this helps them understand the error of their ways
3. some I simply billed the patient and let the patient argue with their insurance.  and yes I'd still do this under the NSA because it was denied.

we generally just don't put up with auth denials in the facility setting.

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Douglas G. Kraus, CPA
Chief Financial Officer
South Texas Radiology Group, P.A.
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Original Message:
Sent: 12-16-2022 15:19
From: Sheila Witous
Subject: Observation denials for preauthorization

I know this matter was being evaluated by the RBMA a few years ago and I wondered if it is still being pursued.  We continue getting preauth/CO denials for advanced imaging studies performed on patients who are in Observation.  From what I understand, our hospitals are not generally getting these denials, hence there is little concern on their part to address the issue.

I would love to hear the experience of others, especially any success you might be having in navigating this very frustrating situation. 

When you add this to the coordination of benefits denials, the requests for additional information from the patient denials, the QMB issues between Medicare and Medicaid, it makes for a ridiculous amount of work.  (Just a little venting on a Friday afternoon).

Thanks to all for serving as such a great resource!

------------------------------
Sheila Witous, MBA, CPA, CGMA
Chief Administrative Officer
Radiology, Inc.
South Bend IN
(574) 258-1100 ext. 205
------------------------------

Douglas,
Thank you for your reply. 

We used to do a little of #3 in certain justifiable circumstances, but now we have a local attorney who is pursuing this against other providers by using class action lawsuits. Without merit, but incredibly time consuming, and we don't want to get caught up in that net!   It truly never ends.

Peace and Merry Christmas to all!​

------------------------------
Sheila Witous, MBA, CPA, CGMA
Chief Administrative Officer
Radiology, Inc.
South Bend IN
(574) 258-1100 ext. 205
------------------------------

Original Message:
Sent: 12-16-2022 15:45
From: Douglas Kraus
Subject: Observation denials for preauthorization

Sheila its good to vent on a Friday.
how about payors denying DBT all of a sudden, bundling doppler and US, a payor after 20+ years telling us we are using the wrong POS code.
Just never stops.

relative to auths:
1. some of our contracts we had it written they could not deny for this in the facility setting, we have no control over the auth process.
2. some I would show them the information i had from the hospital wherein they were paid and we weren't.  usually this helps them understand the error of their ways
3. some I simply billed the patient and let the patient argue with their insurance.  and yes I'd still do this under the NSA because it was denied.

we generally just don't put up with auth denials in the facility setting.

------------------------------
Douglas G. Kraus, CPA
Chief Financial Officer
South Texas Radiology Group, P.A.

Original Message:
Sent: 12-16-2022 15:19
From: Sheila Witous
Subject: Observation denials for preauthorization

I know this matter was being evaluated by the RBMA a few years ago and I wondered if it is still being pursued.  We continue getting preauth/CO denials for advanced imaging studies performed on patients who are in Observation.  From what I understand, our hospitals are not generally getting these denials, hence there is little concern on their part to address the issue.

I would love to hear the experience of others, especially any success you might be having in navigating this very frustrating situation. 

When you add this to the coordination of benefits denials, the requests for additional information from the patient denials, the QMB issues between Medicare and Medicaid, it makes for a ridiculous amount of work.  (Just a little venting on a Friday afternoon).

Thanks to all for serving as such a great resource!

------------------------------
Sheila Witous, MBA, CPA, CGMA
Chief Administrative Officer
Radiology, Inc.
South Bend IN
(574) 258-1100 ext. 205
------------------------------