Insurance Committee Report

Fraudulent Investigations ⎯ Please note that Blue Cross Blue Shield is going an extra mile investigating “Fraudulent” claims by providers. They are encouraging patients to “call in” if they have any reservations about their provider’s billing. On that note, it is important that you, as a Provider, keep an open line of communication with your […]

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Insurance Committee Report

Highlights from the State Meeting Presentation – October 2019 Highlights from the State Meeting Presentation – October 2019 Always have an updated fee schedule for all of your private insurance carriers. Blue Cross/Blue Shield releases a fee schedule three times a year – January 1st – June 1st – October 1st Blue Review Newsletter (from […]

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Insurance Committee Report

How to Navigate Medicare DME Same & Similars There has been a policy with the DME MACs that has been present that is now being enforced.  The summary of this policy is that patients can only get 1 AFO type device per limb every 5 years.  The 5 years includes devices dispensed at another facility […]

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Insurance Committee Report

Important Ulcer Debridement Documentation Update Thorough documentation for debridement of ulcerations is essential for medical records and to ensure proper payment. Insurance companies will request documentation for these procedures and will request refunds if certain criteria is not reported. Please remember to include the following when documenting ulcer debridements: Decision to perform excisional ulcer debridement […]

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Insurance Committee Report

Important DME Update The DME MACS have begun enforcing a long standing policy of “Same of Similar”. Providers who dispense DME products will start getting rejections – reason codes – M3 – which means that the beneficiary has had a similar DME produce within the past 5 years. The “Same or Similar” policy states that […]

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Insurance Committee Report

THERE ARE A LOT OF COMPANIES COMING AROUND WITH REGENERATIVE WOUND CARE PRODUCTS. MY QUESTIONS ARE -WHAT HAPPENS WHEN THE INSURANCE COMPANY DOES NOT PAY FOR THE PRODUCT AND SHOULD YOU USE THE APPLICATION CODE ALONG WITH A DEBRIDEMENT CODE ON EACH VISIT? These Regenerative Products (Q code products), although very beneficial to the healing […]

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Insurance Committee Report

Is board certification required in the credentialing process by insurance companies to be a provider? For some reason this has been a hot topic amongst residents. I could not find any insurance companies i.e.; Blue Cross/Blue Shield, Cigna, United, Medicare etc. in the Midwest Region that require or will require Board Certification in order to […]

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