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Question about authorizations....

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  • Carol Roush
    Hello,   I work in a speech clinic as a receptionist.  I m still pretty new to the clinic (3 months now) and still learning new stuff everyday.  I have a
    Message 1 of 5 , Oct 2, 2008
      Hello,
       
      I work in a speech clinic as a receptionist.  I'm still pretty new to the clinic (3 months now) and still learning new stuff everyday.  I have a question about authorizations and back dating.  Here is my situation.  I over looked that a new client needed authorization approval for the appointment.  I'm so use to them coming in through the fax machine.  This one slipped by me.  The appointment was yesterday.  I just called the clients doctor to have them submit for visits to be approved.  The first session was yesterday.  I'm hoping that the referral person in the pediatricians office can back date the auth request to start from yesterday.  Can that be done when the appointment already happened?  I'm really stressing because my boss is going to yell at me.  Help please? 
       
      Thanks




      [Non-text portions of this message have been removed]
    • Lin
      No..no no.. the doctor or providers office should NEVER backdate..that can be considered fraud. However.. be honest with the carrier..usually there is a
      Message 2 of 5 , Oct 2, 2008
        No..no no.. the doctor or providers office should "NEVER" backdate..that can
        be considered fraud. However.. be honest with the carrier..usually there is
        a 24-48 hour grace period anyway, THEY can backdate the auth, but you
        shouldn't nor should any other provider. I have had carriers backdate a lot
        of authorizations, usually they don't' give you a problem and especially if
        it's just a day or two.





        Linda Walker

        Practice Managers Resource & Networking Community
        <http://www.billerswebsite.com> http://www.billerswebsite.com
        A division of K&L Media, LLC
        <http://www.klmediallc.com> http://www.klmediallc.com

        Website Design & Management for the Medical Services Industry





        From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
        On Behalf Of Carol Roush
        Sent: Thursday, October 02, 2008 4:29 PM
        To: MedicalBillers@yahoogroups.com
        Subject: [MedicalBillers] Question about authorizations....



        Hello,

        I work in a speech clinic as a receptionist. I'm still pretty new to the
        clinic (3 months now) and still learning new stuff everyday. I have a
        question about authorizations and back dating. Here is my situation. I
        over looked that a new client needed authorization approval for the
        appointment. I'm so use to them coming in through the fax machine. This
        one slipped by me. The appointment was yesterday. I just called the
        clients doctor to have them submit for visits to be approved. The first
        session was yesterday. I'm hoping that the referral person in the
        pediatricians office can back date the auth request to start from yesterday.
        Can that be done when the appointment already happened? I'm really
        stressing because my boss is going to yell at me. Help please?

        Thanks

        [Non-text portions of this message have been removed]



        __________ Information from ESET Smart Security, version of virus signature
        database 3490 (20081002) __________

        The message was checked by ESET Smart Security.

        http://www.eset.com



        [Non-text portions of this message have been removed]
      • Carol Roush
        Thanks Lin.  I will tell my boss that when she gets ready to yell at me.    Carol ... From: Lin Subject: RE: [MedicalBillers]
        Message 3 of 5 , Oct 2, 2008
          Thanks Lin.  I will tell my boss that when she gets ready to yell at me. 
           
          Carol

          --- On Thu, 10/2/08, Lin <italiandoll1967@...> wrote:

          From: Lin <italiandoll1967@...>
          Subject: RE: [MedicalBillers] Question about authorizations....
          To: MedicalBillers@yahoogroups.com
          Date: Thursday, October 2, 2008, 2:16 PM






          No..no no.. the doctor or providers office should "NEVER" backdate..that can
          be considered fraud. However.. be honest with the carrier..usually there is
          a 24-48 hour grace period anyway, THEY can backdate the auth, but you
          shouldn't nor should any other provider. I have had carriers backdate a lot
          of authorizations, usually they don't' give you a problem and especially if
          it's just a day or two.

          Linda Walker

          Practice Managers Resource & Networking Community
          <http://www.billersw ebsite.com> http://www.billersw ebsite.com
          A division of K&L Media, LLC
          <http://www.klmedial lc.com> http://www.klmedial lc.com

          Website Design & Management for the Medical Services Industry

          From: MedicalBillers@ yahoogroups. com [mailto:MedicalBillers@ yahoogroups. com]
          On Behalf Of Carol Roush
          Sent: Thursday, October 02, 2008 4:29 PM
          To: MedicalBillers@ yahoogroups. com
          Subject: [MedicalBillers] Question about authorizations. ...

          Hello,

          I work in a speech clinic as a receptionist. I'm still pretty new to the
          clinic (3 months now) and still learning new stuff everyday. I have a
          question about authorizations and back dating. Here is my situation. I
          over looked that a new client needed authorization approval for the
          appointment. I'm so use to them coming in through the fax machine. This
          one slipped by me. The appointment was yesterday. I just called the
          clients doctor to have them submit for visits to be approved. The first
          session was yesterday. I'm hoping that the referral person in the
          pediatricians office can back date the auth request to start from yesterday..
          Can that be done when the appointment already happened? I'm really
          stressing because my boss is going to yell at me. Help please?

          Thanks

          [Non-text portions of this message have been removed]

          __________ Information from ESET Smart Security, version of virus signature
          database 3490 (20081002) __________

          The message was checked by ESET Smart Security.

          http://www.eset com

          [Non-text portions of this message have been removed]


















          [Non-text portions of this message have been removed]
        • Lin
          Missing an authorization here and there is NOT abnormal.. I did MOSTLY mental health and you can imagine the authorizations I had to obtain, enter and track.
          Message 4 of 5 , Oct 2, 2008
            Missing an authorization here and there is NOT abnormal.. I did MOSTLY
            mental health and you can imagine the authorizations I had to obtain, enter
            and track.

            Of course I missed a few.

            Don't let your boss get to you.. mistakes happen.





            Linda Walker

            Practice Managers Resource & Networking Community
            <http://www.billerswebsite.com> http://www.billerswebsite.com
            A division of K&L Media, LLC
            <http://www.klmediallc.com> http://www.klmediallc.com

            Website Design & Management for the Medical Services Industry







            From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
            On Behalf Of Carol Roush
            Sent: Thursday, October 02, 2008 5:21 PM
            To: MedicalBillers@yahoogroups.com
            Subject: RE: [MedicalBillers] Question about authorizations....



            Thanks Lin. I will tell my boss that when she gets ready to yell at me.

            Carol

            --- On Thu, 10/2/08, Lin <italiandoll1967@...
            <mailto:italiandoll1967%40yahoo.com> > wrote:

            From: Lin <italiandoll1967@... <mailto:italiandoll1967%40yahoo.com> >
            Subject: RE: [MedicalBillers] Question about authorizations....
            To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>

            Date: Thursday, October 2, 2008, 2:16 PM

            No..no no.. the doctor or providers office should "NEVER" backdate..that can
            be considered fraud. However.. be honest with the carrier..usually there is
            a 24-48 hour grace period anyway, THEY can backdate the auth, but you
            shouldn't nor should any other provider. I have had carriers backdate a lot
            of authorizations, usually they don't' give you a problem and especially if
            it's just a day or two.

            Linda Walker

            Practice Managers Resource & Networking Community
            <http://www.billersw ebsite.com> http://www.billersw ebsite.com
            A division of K&L Media, LLC
            <http://www.klmedial lc.com> http://www.klmedial lc.com

            Website Design & Management for the Medical Services Industry

            From: MedicalBillers@ yahoogroups. com [mailto:MedicalBillers@ yahoogroups.
            com]
            On Behalf Of Carol Roush
            Sent: Thursday, October 02, 2008 4:29 PM
            To: MedicalBillers@ yahoogroups. com
            Subject: [MedicalBillers] Question about authorizations. ...

            Hello,

            I work in a speech clinic as a receptionist. I'm still pretty new to the
            clinic (3 months now) and still learning new stuff everyday. I have a
            question about authorizations and back dating. Here is my situation. I
            over looked that a new client needed authorization approval for the
            appointment. I'm so use to them coming in through the fax machine. This
            one slipped by me. The appointment was yesterday. I just called the
            clients doctor to have them submit for visits to be approved. The first
            session was yesterday. I'm hoping that the referral person in the
            pediatricians office can back date the auth request to start from
            yesterday..
            Can that be done when the appointment already happened? I'm really
            stressing because my boss is going to yell at me. Help please?

            Thanks

            [Non-text portions of this message have been removed]

            __________ Information from ESET Smart Security, version of virus signature
            database 3490 (20081002) __________

            The message was checked by ESET Smart Security.

            http://www.eset com

            [Non-text portions of this message have been removed]

            [Non-text portions of this message have been removed]



            __________ Information from ESET Smart Security, version of virus signature
            database 3490 (20081002) __________

            The message was checked by ESET Smart Security.

            http://www.eset.com



            [Non-text portions of this message have been removed]
          • Melinda
            Carol, It totally depends on how the insurance co. you re working with operates and their policies on referrals. Sometimes they want retro or back dated
            Message 5 of 5 , Oct 3, 2008
              Carol,

              It totally depends on how the insurance co. you're working with operates
              and their policies on referrals. Sometimes they want "retro" or back
              dated referrals, if warranted; however, it's usually only for a day or
              two. We're PCP and I work with an ins. co. and they are heavily into
              referrals. I rarely have to "back date" a referral. Many times I won't
              back date though...esp. if it's 6 mos. after the fact and the
              specialist's office is calling me because they screwed up. However, if
              it's our screw up and it's recently caught, then we will attempt a
              "retro" referral.

              All in all, it is not the best policy to retro or back date referrals on
              a routine basis. Really, it is up to the patient to make sure it's in
              place, before you see them. And it's up to the specialist's offices to
              catch them, when they come in the door; and reschedule, if necessary, or
              have them sign an ABN, if the referal isn't authorized.

              If I were a specialists office, I'd verify all insurances before the
              patient is seen each time and then you'll know when they change
              insurances and if their ins. needs a referral. Also, check out the
              patients that need referrals, a week in advance, that way you have time
              to get one if needed. I tell my specialist's offices and patients that
              I need 2 weeks to process a referral, in order for the patient to get
              the letter in the mail and the specialists office too. In reality, I
              usually only get 1-3 days notice from their offices.

              I can tell you from a PCP standpoint, we really don't appreciate the
              calls from the specialist's office, when the patient is standing in
              front of them, saying they need a referral. That referral request is at
              the bottom of my to-do list. Now, urgent work ins, hospitalizations,
              etc....that's a different story.

              They will often ask me if I can get it to them today. I tell them I
              don't know...I'll try. They ask if they should reschedule the patient
              and I tell them it's up to them, but if they don't get the referral and
              the patient doesn't sign an ABN, then they can't be billed. It's up to
              them what they do now.

              I can send you my Referral Request Form I developed, if you'd like. I
              request the form be completed by my "problem" offices, before a referral
              will be done.

              Email me if you want the form: melindadocsmith@...
              <mailto:melindadocsmith@...>

              Hope this helps!

              Melinda Brown, CMBS
              Ins Biller


              --- In MedicalBillers@yahoogroups.com, Carol Roush <carollroush@...>
              wrote:
              >
              > Hello,
              >
              > I work in a speech clinic as a receptionist. I'm still pretty new to
              the clinic (3 months now) and still learning new stuff everyday. I have
              a question about authorizations and back dating. Here is my situation.
              I over looked that a new client needed authorization approval for the
              appointment. I'm so use to them coming in through the fax machine.
              This one slipped by me. The appointment was yesterday. I just called
              the clients doctor to have them submit for visits to be approved. The
              first session was yesterday. I'm hoping that the referral person in the
              pediatricians office can back date the auth request to start from
              yesterday. Can that be done when the appointment already happened? I'm
              really stressing because my boss is going to yell at me. Help please?
              >
              > Thanks
              >
              >
              >
              >
              > [Non-text portions of this message have been removed]
              >




              [Non-text portions of this message have been removed]
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