Be careful when helping referring physicians with precertification
Compliance Monitor, November 17, 2006
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Q: Can an independent diagnostic testing facility (IDTF) help referring physicians obtain precertification approval from insurers or radiology intermediary groups?
A: No, it is the referring physician's responsibility to obtain the precertification prior to the patient's arrival at the IDTF for the exam.
If the referring physician fails to obtain a precertification, or if insurers (or their agents) refuse precertification because of lack of medical necessity, the claim for the imaging service gets denied. So, radiologists do not get paid without proper precertification paperwork.
This leads some to be tempted to assist physician groups with the precertification approval process, but this can be a slippery slope in terms of insurer agreements and government scrutiny.
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