Listserv Lately 11
by Suzan Hvizdash, CPC, CRN Senior Auditor, Instructor
We started last week off with an unusual insurance policy. Apparently the patient was injured in an auto accident. The other driver had a few drinks. It was written into the patient’s insurance contract that they don’t pay for any injuries sustained as a result of alcohol. (I hope I got that right!) This exclusion seemed a bit odd, and more so, difficult to prove. What are the criteria? Blood alcohol level? Number of drinks? Type of vodka? Red or White wine? How does an insurance company determine that their member shouldn’t be reimbursed for an injury resulting from a situation beyond their control? Is this fightable? Could these services be billable to the auto insurances? I’m interested to know how this one turns out!
“The most ridiculous denial I have seen” was the title of a long chain regarding insurance companies denying EKGs as being bundled into a knee injection. How can these two procedures be considered related enough to bundle? The insurance company stated that “certain procedures are commonly performed in conjunction with other procedures…and is clinically integral to the successful outcome of the primary procedure.” Well, out list was quite vocal on recommendations on how to pursue this one. One poster suggested the lister look at how the two procedures were billed. If both lines referred to both procedures, this type of denial could result. If, however, the EKG was pointed to the chest pain and the injection was pointed to the knee issue, then this is definitely worth fighting. Send a letter to the insurance and make certain you CC the CEO was another suggestion as this is something they’ve been called on in the courts recently.
What about the situation where the doctor didn’t want to write a complete Operative Note? He was questioning the components of the note and a lister asked for references to help guide the physician.
The new CPT guidelines came out and some returned from the AMA symposium with some new insights. Thanks for sharing! The 2006 Medicare fee schedule was posted this week. Barbara gave us the http://tinyurl.com/akvtb and Don helped by separating the fee schedule into localities http://www.donself.com/documents/2006/2006MFS.html.
To discuss or not to discuss fees, that is the question. Is it “allowed”, “appropriate”, “legal” to discuss fees on a list serve? This brought in a lot of opinions regarding price fixing, price comparisons, etc. Got conversation check it out http://health.groups.yahoo.com/group/CRN-L/message/50164.
There were a lot of diagnosis coding questions asked this go-around, including information about the ICD-9, Volume 3. Most everyone got at least one or two responses to their questions. I’m sure they were helpful. If you find you post a question and don’t get a response, try again. Everyone is there for you and we certainly don’t want anyone to feel they can’t come to us with their perplexing issues.
Have a great end of November!
Until next time,
Joining the list serve: $0
Asking questions on the list serve: $0
Advice received on the list serve: Priceless
Reading your bi-weekly CRN newsletter: $0
The value of reading your bi-weekly CRN newsletter: Priceless
Suzan