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I am trying to get black and white paper evidence about this topic. My Dr is wanting to bill for the peer to peer review that is needed when getting a prior authorization. It was my understanding that this is not possible and is included in the surgical package. If anyone can give me any information I would be most grateful. Please let me know if you have a link that I am able to research and print out. Also, please let me know if I am incorrect.
thanks in advance
The Centers for Medicare and Medicaid Services (CMS) have released an update to the prior authorization process for certain durable medical equipment, prosthetic, orthotics, and supplies (DMEPOS) items. As originally announced in the Federal Register, published on December 21, 2016, CMS is preparing for the nationwide expansion of the prior authorization process for the first […]
AAPC Knowledge Center
I have a provider who is planning a dx hscope 58555 with POSSIBLE LOA 58559 and POSSIBLE polypectomy 58558 for intrauterine filling defect (of which ICD10 I am unsure to use), recurrent pregnancy loss, and acquired absent fallopian tube.
When requesting authorization for the surgery, how would you recommend I proceed? Include all cpt’s?
Thank you in advance for your assistance!
The Centers for Medicare & Medicaid Services (CMS) issued a final rule on Dec. 21, 2016, establishing a prior authorization process as a condition of payment for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) beyond power mobility devices (PMDs). The new process will use a “Master List” of items that meet specific criteria and are potentially […]
AAPC Blog
This article continues our series focusing on how to avoid radiology claims denials. In our first article, we covered Patient Eligibility Problems. Now let’s look at the topic of procedure authorization, specifically the failure to obtain proper authorization before the service is performed.
