Guest guest Posted June 13, 2012 Report Share Posted June 13, 2012 Some HMOs require the referral/PA to be done by the PCP ( just learned that after 60” on the phone yesterday)Makes sense to someone….. From: [mailto: ] On Behalf Of Ardiana MalokuSent: Wednesday, June 13, 2012 10:36 AMTo: IMPSubject: Pre Certification Hi everyone,We have a patient that wants to see a specific OBGYN so the office called and requested a referral which is fine(we can do that) but then that same office wanted me to get a pre certification for an ultrasound that the obgyn wants to get done and she gave me the cpt code that the obgyn dx the patient. I am very confused? Do we have to get that Pre certification if the OBGYN is the one who is wanting the procedure??? I feel like we're doing everyone's work! Is this correct? Ardiana TeranOrange Doc Family MedicineClermont, FL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2012 Report Share Posted June 13, 2012 I know in my experience, some plans do require everything to go through the gate-keeper PCP; I guess with the idea of non-duplication of services (you've already had a pelvic US done someplace else, so the GYN shouldn't get paid to duplicate in their office). I understand the logic and also acknowledge that it adds a burden to the PCP. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com yeah bizarre request Maybe someone new there? If you did not send the pateitn or did not order the test well you/ one should rarely " just " do paperworkReferrals arise out of my inability to provide what someone needs, so I refer IN other words I see them and take care of them What a conceptOccasionally there ar e exception s Certainly I do not PA someone else's choice of tests Bizarre. Most GYN is self-referred as considered primary care so no referrals are needed. Also, any test they order they can prior auth and need to do themselves. There might be a plan that is an exception but usually this is the way it is. And we have to fight the specialist all the time but stand firm so the behavior stops. Kathy Saradarian From: [mailto: ] On Behalf Of Ardiana Maloku Sent: Wednesday, June 13, 2012 11:36 AMTo: IMPSubject: Pre Certification Hi everyone,We have a patient that wants to see a specific OBGYN so the office called and requested a referral which is fine(we can do that) but then that same office wanted me to get a pre certification for an ultrasound that the obgyn wants to get done and she gave me the cpt code that the obgyn dx the patient. I am very confused? Do we have to get that Pre certification if the OBGYN is the one who is wanting the procedure??? I feel like we're doing everyone's work! Is this correct? Ardiana Teran Orange Doc Family MedicineClermont, FL -- MD ph fax Quote Link to comment Share on other sites More sharing options...
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