ateramana
New
I have a question and was hoping someone could help. I work for an infertility clinic and we have a protocol for a procedure that no matter the medical necessity we still perform the procedure because we get better results. If we call and can not get auth for it, are we still obligated to bill it to the insurance for a denial? Also if they end up paying it after denying auth for it and we sent the medical records in for review, is it fraud to keep the payment? Infertility is a hard specialty to bill for because alot of insurances are not familiar with the procedures. I always thought that no matter what the outcome of payment is for a procedure, we still had to bill for it because we provided the service. Is there a modifier we could add to the procedure to show we might not meet the criteria for payment? Thanks.