Practice Management

Colleagues - Will anyone who has filed a 2nd-level appeal (Reconsideration) or an ALJ Hearing please contact me privately? In 2018, the CMDs of J5 and J8 issued a list of 13 x-rays that they consider inadequate or hazardous to the patient and have denied payment. The list of x-rays includes rib and facial CPT codes for which we bill globally. We've filed approximately 60 appeals with mostly unfavorable results and will take our case to the next level.  I'm looking for advice on what to include in the request to make it effective – specifically what kind of clinical evidence to submit.

 

Thank you in advance, Brigette.  714-269-4476 or blabar@cox.net 

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Brigette LaBar FRBMA
Project Management | Consulting | Interim Leadership
Escondido CA

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Brigette,
In my experience, once you jump through all the hoops and get to the ALJ level you won’t have an issue. If you can document a strong case then they will likely settle in your favor.
It takes a lot of time and effort to get there and unlikely you will redeem any of those costs.

Neale


Original Message------

Colleagues - Will anyone who has filed a 2nd-level appeal (Reconsideration) or an ALJ Hearing please contact me privately? In 2018, the CMDs of J5 and J8 issued a list of 13 x-rays that they consider inadequate or hazardous to the patient and have denied payment. The list of x-rays includes rib and facial CPT codes for which we bill globally. We've filed approximately 60 appeals with mostly unfavorable results and will take our case to the next level.  I'm looking for advice on what to include in the request to make it effective – specifically what kind of clinical evidence to submit.

 

Thank you in advance, Brigette.  714-269-4476 or blabar@cox.net 

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Brigette LaBar FRBMA
Project Management | Consulting | Interim Leadership
Escondido CA

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