DATING ADVICE
FROM A PRO
Yes, you read that right. I am
going to give you some real
dating tips. These may not
be the kind of dating tips you
want, but they’re the kind you
need.
Once your patients have been
deemed worthy or sick enough
to get needed treatment, they
are given the stamp of ap-
proval and you are good to
go, right? Well, yes and no, be-
cause in most cases that green
light comes with an expiration
date.
An approval from most plans
will say “yes you meet the
guidelines for coverage but
only if you complete the ser-
vices within a 6 week window.”
It seems like just another way
for insurance companies to
avoid paying for claims as they
can deny the claim and stamp
“services provided after ap-
proval date!” At GoGo Billing,
we request a year but usually
get a 3 month window.
This potentially huge problem
becomes a non-issue with just
a few simple steps.
1. Have your patients commit
to treatment, take impres-
sions and send the case to the
lab and schedule them 4 weeks
out for delivery. Inform your
patient you will be contacting
the plan to see if a pre-autho-
rization is required and if it
not approved by the time their
appliance comes in you may
have to move them out a week
or two. Not only will this dra-
matically increase case accep-
tance but will help when given
small windows to work with.
2. Call for an extension BEFORE
you deliver the appliance if
the approval date has expired.
Most plans will do this without
an issue, but if you submit a
claim and they know the ser-
vices have been rendered it’s
an easy denial and it will be
denied. The only recourse is a
lengthy appeals process. Just
get the extension.
3. Don’t forget about the GAP
approval. Obtaining this ex-
tension is not as easy, and
most plans will require a new
one be submitted. These can-
not be extended because a
new search for an in-network
LESIA CRAWFORD
provider will have to be con-
ducted. My best advice on a
GAP approval is to again pay
close attention to the dates
and not get into this position.
I speak on behalf of every bill-
ing company when I say these
dates of approval are hog-
wash! Yet we have to play by
the rules. Do not let insurance
companies deprive your pa-
tients of the treatment they
need or you of the valuable
production.
Pay close attention, double
and triple check those dates
for your E0486, and remember
bill on the delivery date!
Lesia Crawford,
CEO of GoGo Billing
GoGo Billing offers help with Tri-
care registration for no charge
and Medicare credentialing
services for DME, Part B and
Ordering and Referring. Enter
code DS3100 for $100.00 off
DME and
Part B credentialing.
Contact me at
[email protected]
or call (877)874-4646 ext. 1