Wiki No Retro Auth Rights

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knperry

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The hospital did not appy for an authorization so I called medicaid to see what I can do in order to get an authorization number. The rep told me that if the authorization was not applied for up to 3 days after the admission date and the patient has no retro rights, then medicaid will not pay. Does this mean that I can bill the patient?

Thanks
 
Wow. That stinks. What state medicaid is that? Here we have 90 days to get a retro. I believe you can only charge the patient if they signed a medicaid abn form.
 
I worked for Mo Medicaid for several years and they had at that time 24 hours from the date of service or admission to notify for authorization, for emergencies. If it was not an emergency they had to prior auth the service within 3 days prior to the service. There were no appeal rights for timeframe violation and the patient could not be charged since it was not the fault of the patient. If you fail to comply with the regulation, or timeframes, this is not something the patient can sign an ABN for nor be charged for.
 
Debra since it was not the doctor's fault would it be worth it to appeal it? Have you seen or heard of anyone winning an appeal for this type of situation?

Thanks
 
It is sort of the Dr. fault as it is viewed as the Dr. office responsibility to make sure all auths have been obtained. You can try an appeal but I do not think it will win. None of our docs that appeal these for timeframe were ever successful.
 
Hey Debra

My doctor is contracted with the hospital. He's an ER doctor and he said they have a department that is suppose to get the authorizationsbut sometimes they fail to do so.
 
no retro auth rights

knperry said:
The hospital did not appy for an authorization so I called medicaid to see what I can do in order to get an authorization number. The rep told me that if the authorization was not applied for up to 3 days after the admission date and the patient has no retro rights, then medicaid will not pay. Does this mean that I can bill the patient?

Thanks
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Absolutely not. You cannot bill a medicaid patient. They do not have the money and it is against the law.
 
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