Re: Burned by Medicare policy?
Description
Collection
Title:
Re: Burned by Medicare policy?
Text:
Randy
I currently have a case in appeal to Region D.
87yo female fell at home, presented to an Urgent Care Clinic. Was treated and
returned home.
2 months later patient went to Orthopod and was prescribed a Hyperextension
brace for her T11 comp Fx. Referred to my office, we rendered servcies and
accepted assignemtn in this case. Calim was denied as patient had received
same or similar device. We appealed and lost. Found out after the fact that
pt had received an elstic binder from Urgent Care clinic. HCFA deemed this to
be same type of device. Hyeprextension brace was denied as not
necessary.Telephone appeal is pending.
We have no recourse other than appeal, no way to check whether patient has
previously received similar device.As the OP provider you are AT RISK with
many services. We have become very careful when we accept assignment. Would
prefer not to provide the servcie than not get paid.
My office name does NOT include BANK any where in the name.
Ralph W Nobbe CPO
I currently have a case in appeal to Region D.
87yo female fell at home, presented to an Urgent Care Clinic. Was treated and
returned home.
2 months later patient went to Orthopod and was prescribed a Hyperextension
brace for her T11 comp Fx. Referred to my office, we rendered servcies and
accepted assignemtn in this case. Calim was denied as patient had received
same or similar device. We appealed and lost. Found out after the fact that
pt had received an elstic binder from Urgent Care clinic. HCFA deemed this to
be same type of device. Hyeprextension brace was denied as not
necessary.Telephone appeal is pending.
We have no recourse other than appeal, no way to check whether patient has
previously received similar device.As the OP provider you are AT RISK with
many services. We have become very careful when we accept assignment. Would
prefer not to provide the servcie than not get paid.
My office name does NOT include BANK any where in the name.
Ralph W Nobbe CPO
Citation
“Re: Burned by Medicare policy?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/216057.
