Neurology & Pain Management Coding Alert

Question: In years past, we required patients to bring in their referral/authorization paperwork in order to be seen by our pain management specialists. That changed after a while, but now we have a new office manager who wants us to get the referral/authorization for every patient to be seen. The problem is that quite a few primary care physicians are slow to get this information to us. My question is: Are we allowed to require patients from certain offices to bring in the authorization/referral on the date of their appointment but still obtain the information ourselves from other doctors’ offices?

Kansas Subscriber

Answer:  The best way to handle this depends on the payer in question.  A few payers say it is the specialist’s responsibility to obtain the authorization, not depend on the referring physician to send the paperwork. If the payer follows this guideline and you don’t get the authorization on behalf of your pain management provider, you can’t charge for the visit. Other payers don’t stipulate who needs to handle the authorization. Find out what your individual payers require and follow their regulations.