Pre-certifications In Medical Billing

Pre-certifications In Medical Billing

In many cases, a rejected claim by a carrier is due to the pre-certification requirements not being met. Many times, procedures will need to be pre-certified by the carrier prior to services being rendered or the carrier simply will not honor the medical billing claim when it is filed.

One way to cut down on your claim rejections, is to have your staff document when they call for a pre-cert when a patient needs a procedure performed.
Have your staff fill out a pre-cert form and call about the procedure for the patient and get the date,time, phone number and extension and full name of whomever gave their approval for the pre-cert.

This information is very useful for your medical billing partner when your claims are filed and in the rare event you should receive a denial of your medical billing claim due to the fact the carrier says no such procedure was authorized, you can have your medical billing partner send an appeal letter, along with the pertinent information regarding who gave their approval for the procedure to be pre-certified in the first place.

Misinformation by an insurance company employee should not result in a financial penalty for your practice and normally when these type of appeals are filed, there is normally a positive outcome for the physician.

Your medical billing partner will always handle your rejected claims and always remember to make sure your staff passes on any helpful notes and paperwork regarding denied claims. One name and phone number can make all the difference in the world between winning and losing an appeal of a rejected medical billing claim.

View all Articles by: Melissa Clark, CCS-P