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Tip: Obtain precertifications as necessary

Ambulatory Surgery Reimbursement Update, August 26, 2008

Do not rely on a physician’s practice to obtain any needed precertifications for you. 

nquire with the payer to determine whether it requires a precertification or authorization for the case. Be detailed and inquire about all scheduled procedures to be performed—not just the first procedure listed on the schedule.

If a precertification is required, obtain it before the surgery. Confirm that the precertification number is on the claim form (another common source of claim denials) before the claim goes out. Also, if procedures change from what was scheduled (and for what the precertification was approved), contact the precertification company within 24 hours of surgery to revise the approved procedures on the precertification to avoid a denial.

This tip is brought to you by Ellis Medical Consulting, Inc.

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