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Pre-cert
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Re: Pre-cert
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BarBara Burton
Re: Pre-cert
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Dec 24 03 3:29 AM
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My Recent Posts
I am the Business Office Manager for a small rural hospital and I am also the SHIP (Senior Health Insurance Coordinator for the state of Illinois) so I actually work both sides of the spectrum.
We certify every admission and outpatient procedure that we know requires it, we have a utilization review nurse that does this. However, I have sat in on meetings at various employers that are presenting new insurance coverage to their employees.
The employee is given their new insurance card along with their coverage manual. NO where in the meetings or the manuals does it say that the ultimate responsibility for pre-cert is the hospital. The employees are told it is their responsibility for precertification. That statement is even made on the back of their insurance cards.
However, we do certify about 95% because we know it helps us get paid as well as performing a courtesy for our patients and try to take away a lot of their concerns.
Sometimes there is the occassional patient that says he is self pay and then when we bill him, he brings in an insurance card. We inform the patient that because he did not provide us with the information that he will probably have to pay a penalty because we could not do a precert.
BarBara
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Association News
Medical Billing & Coding Education from the MAB
Continuing Education
Management Advice and Training
Questions Asked More Than Once
Help Wanted - Billing and Coding
Non Billing Talk
The Venting Area (Clean posts please)
Medical Coding and Billing News
Fraud and Abuse
Health Insurance - Provider Contracting
ERISA
Tricare
Workers' Compensation
General Medical Billing Questions
Appeals
Accounts Receivables (A/R)
Refunds
Auto Accident Issues
Medisoft Technical Support
Medical Software Technical Support Questions Other than Medisoft. No Investigation Questions!
General Medical Coding Forum
CPT Coding Questions
HCPCS Coding Questions
ICD-9-CM Coding Questions
Evaluation & Management Coding Questions
Acupuncture Billing and Coding
Ambulance Coding and Billing
Cardiology Coding and Billing
Chiropractic Coding and Billing
Dental Billing and Coding
DME Coding and Billing
Emergency Department Coding and Billing
Family Practice Coding and Billing
Hospital Inpatient and Outpatient Coding
Hospital Billing, Appeals and Collections
Internal Medicine Coding and Billing
Laboratory Coding and Billing
Ophthalmology Coding and Billing
OB-GYN Coding and Billing
Pain Management Coding and Billing
Pediatric Coding and Billing
Podiatry Coding and Billing
Physical Therapy Coding and Billing
Psychiatry Coding and Billing
Radiology Coding and Billing
Surgery Coding and Billing
Neurology Coding and Billing
Urgent Care Coding and Billing
Provider Compliance
Billing Center Compliance
HIPAA
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