daedolos
Expert
How would one go about filing an appeal for an expired surgery auth for said surgery done three days later?
Peace
?_?
This is for an ongoing DOL claim.
Peace
?_?
This is for an ongoing DOL claim.
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Appeals
- Thread starter daedolos
- Start date
I would assume that this is for a non Medicare or Medicaid carrier. With that said, there are a few things you will need to include and address to have a shot at getting this service paid if you were outside of the authorization range:
1. Identify the reason that the service was not performed during the specified dates. Issue scheduling at the facility? Medical issues that caused the surgery to be postponed? etc. If it was just an oops, be honest and say that.
2. You will need to provide medical justification/necessity showing that the service was still medically justified at the time of service.
I would write a letter in addition to providing them with a copy of the expired authorization and medical records outlining the reason the service was performed outside of the timeframe along with proof that the service was still medically justified.
You may also want to try calling the authorization unit and seeing if they will make and adjustment to the authorization date range. Sometimes it can be as simple as a phone call. But if you do need to appeal make sure to address the information above and ask for payment based on services rendered as an exception.
1. Identify the reason that the service was not performed during the specified dates. Issue scheduling at the facility? Medical issues that caused the surgery to be postponed? etc. If it was just an oops, be honest and say that.
2. You will need to provide medical justification/necessity showing that the service was still medically justified at the time of service.
I would write a letter in addition to providing them with a copy of the expired authorization and medical records outlining the reason the service was performed outside of the timeframe along with proof that the service was still medically justified.
You may also want to try calling the authorization unit and seeing if they will make and adjustment to the authorization date range. Sometimes it can be as simple as a phone call. But if you do need to appeal make sure to address the information above and ask for payment based on services rendered as an exception.
daedolos
Expert
Thank you for the pointers.
Peace
@_*
I've started the ball rolling by filing a generic appeal form just in case there is a short time frame. I'll send a detailed form with explanations (scheduling issue with patient) as well as extra documentation for medical necessity. The initial final decision was rendered on 8-24-17 regarding no more claims allowed.
Peace
@_*
I've started the ball rolling by filing a generic appeal form just in case there is a short time frame. I'll send a detailed form with explanations (scheduling issue with patient) as well as extra documentation for medical necessity. The initial final decision was rendered on 8-24-17 regarding no more claims allowed.