I have a problem that I hope our group can help me with. Several years ago our hospital hired a RN to do Utilation Review for hospital admissions, surgeries, CT's MRI's and Physical Therapy.
Now, it appears the nurse is too busy with other things to do so they want our hospital patient accounting department to do all pre-certs.
We used to do them, years ago, before her hire, but the pre-cert requirements have changed and they always ask for clinical information, which the business office does not have so we have to end up paging a nurse to give the clinical information or if the nuse was not available, she would have to call them back the next day. The insurance companies would not pre-cert without the clinical information.
I do realize that the patient is ultimately responsible for the pre-cert but there are times when the patient is too sick and does not have family with him.
Our business office is working less 2 employees because of budget restraints so we are very short handed and I do not know how we are going to find the time to do all pre-certs and we won't have the clinical information anyway.
We like to assist the patient in their certification as a courtesy and customer service enhancement but our business office does not have the time.
This issue has come up becuase we had several hospital admissions and physical therapy claims that were not certified and the patients are complaining to our Adminastrator. When the claims are not certified, it does hurt our collection process.
Can anyone give me their thoughts and ideas? I would appreciate any and all help.
Thanks in advance,
BarBara
Now, it appears the nurse is too busy with other things to do so they want our hospital patient accounting department to do all pre-certs.
We used to do them, years ago, before her hire, but the pre-cert requirements have changed and they always ask for clinical information, which the business office does not have so we have to end up paging a nurse to give the clinical information or if the nuse was not available, she would have to call them back the next day. The insurance companies would not pre-cert without the clinical information.
I do realize that the patient is ultimately responsible for the pre-cert but there are times when the patient is too sick and does not have family with him.
Our business office is working less 2 employees because of budget restraints so we are very short handed and I do not know how we are going to find the time to do all pre-certs and we won't have the clinical information anyway.
We like to assist the patient in their certification as a courtesy and customer service enhancement but our business office does not have the time.
This issue has come up becuase we had several hospital admissions and physical therapy claims that were not certified and the patients are complaining to our Adminastrator. When the claims are not certified, it does hurt our collection process.
Can anyone give me their thoughts and ideas? I would appreciate any and all help.
Thanks in advance,
BarBara
