Courtesy of Sheri Frost
You cannot convert a patient to cash if their condition meets medical necessity based on the payer guidelines. If you do not receive the requested number of visits for prior authorization, then you must submit for more based on medical necessity, VAS, and subjective information.
The payer is looking for medical necessity, and it must be documented in patient notes. Document everything on the prior authorization form. Peer-to-peer requests should be utilized, and your patient should be involved in contacting their insurance directly. Check out the helpful links below:
- How visits are approved (scroll to the section on chiropractic)
- Peer-to-Peer Scheduling Request
- Chiropractic Requirements for Authorization
- Affected Codes
- Requesting More Visits