Medicare

Hi all, this a question in general ---Does Medicare deny claim requesting for an Auth from the provider by any means If yes why and what cases do they request for an Auth..?

re: Medicare

Have never had Medicare to require an auth.

re: Medicare

If it is a Medicare Managed Care payer, then yes, they usually do require authorization. If this is the case and the patient did not reveal that they had moved to a Managed Care plan, you will need to contact both patient and payer and discuss that issue. Hospitals do have a way to determine if a Managed care plan is in effect on the day of service. However, do not believe physicians can access that information unless they have a financial interest in the case (have rendered a service).


For traditional Medicare, I have known them to ask for a copy of the request for services from the requesting physician.