Exhibit 4 shows a sample prior authorization letter. The exact choice of codes will depend on the standard coding practices of the physicians in your community and on each insurer. Physician Office Coding Diagnosis Codes. Please note that plans may have specific billing requirements. Hospitals use revenue codes developed by the American Hospital Association to bill for services and supplies furnished during an outpatient encounter.
Most patients share the cost of medical care through copayments and deductibles.
However, patients insured by Medicaid and some managed care plans will have minimal or no copayments or deductibles. Private payers typically reimburse for physician services based on charges, discounted charges, or on a fee schedule. Most Medicaid programs reimburse physicians for their services according to a fee schedule, and for drugs according to estimated or actual acquisition cost. Most private payers reimburse for hospital outpatient care based on charges, discounted charges, or costs. Depot Reimbursement Hotline can also assist you in processing initial claims.