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RE: [CRN-L] WC Billing Help- Denials

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  • Ken Mailly
    There is more to this question than can really be addressed by e-mail alone, but there are a few critical points that I think need to be made. 1-97150 is an
    Message 1 of 4 , Mar 4, 2005
      There is more to this question than can really be addressed by e-mail alone,
      but there are a few critical points that I think need to be made.

      1-97150 is an untimed code, and therefore can only be billed once per date
      of service.

      2-As this group well knows, CPT is copyrighted, and these codes cannot be
      defined on the fly, and at our whim.

      3-While CMS has its' own extensive coverage, coding and documentation
      requirements, other payers are increasingly following them. We know this
      because we are working with some of these payers on doing so.

      4-For better or worse, these types of claims involve more than a claim form.
      The backup documentation is frankly even more important than the 1500.

      I can tell you first-hand that the reviews of documentation we are
      performing seldom support the billing we are seeing. Providers have no one
      to blame but themselves for this problem.

      Ken Mailly, PT
      Mailly & Inglett Consulting, LLC
      Tel. 973 692-0033
      Fax 973 633-9557
      68 Seneca Trail
      Wayne, NJ, 07470
      www.NJPTAid.biz

      Bridging the Gap!


      -----Original Message-----
      From: AmLee Billing Services [mailto:amlee_billing@...]
      Sent: Tuesday, March 01, 2005 11:44 PM
      To: CRN-L; PMOM; Amba
      Subject: [CRN-L] WC Billing Help- Denials


      What is the best way to respond to WC denials of care based on the
      limitations of the Medicare Guidelines. More and more I am seeing
      the IC denying rehab over 45 minutes based on the Medicare Treatment
      Guidelines that state only 30 to 45 minutes are needed.

      What is the best way to handle this when filing for reconsideration's? I
      wanted to get other opinions before I went with what I feel is the best
      solution. My problem is the IC denying any more than 3 units on therapeutic
      exercises 97110 or 97150. Medicare is suppose to be a fee guideline and not
      a treatment guideline, but the IC is using the guidelines as a treatment
      guideline.

      Thanks,

      Amie Pennington-White CCHRS;CMHRS;CMRS;CPC;MA;CNA;RNA
      CEO AmLee Billing Services
      Office: (817) 676-2221
      Fax: (817) 788-2175
      www.amleebillingservices.com



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