A few months ago, Aetna released a new policy indicating they will no longer pay for 97140 (manual therapy techniques) when performed on the same date of service as a CMT code (9894x). This even includes billings where the provider appends the -59 modifier (appropriately or inappropriately).
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The Office of Inspector General (OIG) Health & Human Services (HHS) of was established 1976 and has been at the forefront of the Nation’s efforts to fight waste, fraud, and abuse in Medicare, Medicaid, and more than 300 other HHS programs. The majority of OIG’s resources go toward overseeing of Medicare and Medicaid, and they develop and distribute resources to assist the health care industry in its efforts to comply with the Nation’s fraud and abuse laws and to educate the public about fraudulent schemes.
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How do I coordinate benefits in a Workers’ Compensation case that involves a Medicare patient?
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In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.
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A large number of questions I receive deal with appealing denied insurance claims and these denials cause most doctors headaches. When a claim has been denied because of medical necessity or because a service is not covered, an important step in the appeals process is to determine if the patient’s plan is a self-funded ERISA plan.
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When you treat family, often your family will want to help you out and suggest that you file the claim for services with the insurance company. Whenever you are going to file a claim for services rendered to family members, always check the policy first.
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Using flexible tape such as Kinesio tape or McConnell tape has become more common, and many chiropractic physicians want to bill insurance for these services. Although there are CPT® codes for taping and strapping, based on information within CPT® supporting documents, these codes should not be used for flexible taping.
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I suggest that before submitting a claim to a 3rd party payer for T.E.N.S. reimbursement, it is important to read the medical policy of the 3rd party to determine if the rental or sale of the machine meets their definition of medical necessity.
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