Referrer Tool Kit
As healthcare costs have continued to rise over the years, insurance carriers have designated certain studies for preauthorization, particularly for high-end imaging procedures. The ever-increasing practice by insurance carriers of requiring preauthorizations for procedures such as MRI, CT and Ultrasound has changed the way medical decisions are made by referring physicians. This extra layer of work has been confusing and expensive to implement. When your patient has an insurance plan that does not require preauthorization or the patient is a “self-pay” patient, requesting a procedure is relatively simple and straightforward. Ordering MRI, CT or Ultrasound for this patient population can be written as simply as “MRI brain, contrast as needed,” or “US pelvis with TVP, if necessary.” Radiologists tailor the protocol for studies in this category based on patient history and symptoms. When the patient’s insurance policy requires preauthorization, it is the responsibility of the referring physician to obtain this preauthorization. Raleigh Radiology cannot assume this responsibility.
The preauthorization process is specific and rigid. When there is conflicting information on the written order and the insurance authorization, our insurance verification staff will contact you to obtain any additional information. In order for the imaging procedure to be covered by the authorization, Raleigh Radiology must follow the specific requirements outlined in the authorization form. Failure to follow the authorization results in non-payment for the services rendered. In order to help our referrers, Raleigh Radiology is committed to providing as much assistance as necessary to ensure accurate orders are in place. If you have any questions, please feel free to call any of our offices.
We have also created this guide to help you determine the appropriate exam based on patient clinical indications. Although we cannot answer every scenario, this guide is intended to provide you with information that is concise and as complete as possible regarding preauthorization and contrast requirements. In these economical times, there is valuable information available to patients to assist them in making informed decisions about their healthcare choices. We encourage you and your patients to utilize the online cost estimator found on most insurance carriers websites.
We hope that you will find these resources useful in determining the appropriate exam for your patients. We appreciate your support as we continue to serve the needs of your practice and patients.
Raleigh Radiology Associates