“The hoops you have to get through vary by payer,” said Kim Pollock, RN, MBA, CPC, CMDP, a consultant with KarenZupko & Associates, Inc. in Chicago. “Some will routinely pay on an unlisted code that is used accurately. Others may not even recognize the unlisted code at all.”
Explore this issue:September 2018
Get Preauthorization When Possible
It is recommended that you approach the payer to get a preauthorization if possible. This speeds up a process that may be slow under the best of circumstances. Even with preauthorization expect delays, as most require human intervention.
“The Academy has a manual for addressing these issues,” said Dr. Manes. “It can be found on the members-only part of the website at entnet.org. This is a very good resource.”
Kurt Ullman is a freelance medical writer based in Indiana.