Re: ALJ HEARING ON THURSDAY

Re: ALJ HEARING ON THURSDAY

Jim Sedlak

6/27/2013

All I ask is please share your responses if you don't mind. I hope to
someday have this same appeal hearing with the ALJ. Just cant get them to
schedule it.

Below is some info I have received from Otto Bock in the past. You may have
this already but I have posted their verbage.

This is to respond to your request, dated ___, for documentation to support
the above claim. The Rationale in your letter stated, Lower limb
prosthetic claims are improperly paid when documentation of patient
rehabilitation potential does not match the lower limb prosthetic as
billed. We would like to point out that the claims selected for audit were
all for bilateral patients. Cigna's LCD for Lower Limb Prostheses (L11442)
states It is recognized within the functional classification hierarchy,
that bilateral amputees often cannot be strictly bound by functional level
classifications, which was the case in this situation

Hope this helps, and Good Luck!
Jim Sedlak

-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Amanda Springer
Sent: Tuesday, June 25, 2013 6:45 PM
To: <Email Address Redacted>
Subject: [OANDP-L] ALJ HEARING ON THURSDAY

 




Hello List,
 
We have our first ALJ Hearing regarding Physician Documentation on a
Bilateral Amputee on Thursday...
 
Anything that I should know.....
 
Anything that I should make sure to bring up to the Judge?
 
ANY INFO./RECOMMENDATIONS WOULD BE FANTASTIC!
 
Thanks,
Amanda