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Medicare Medicaid
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Medical Practice Management
Company Influences Major Reimbursement Policies
by June Marshall-kingsley
mpowermed, inc., a medical practice management company in Mahwah, NJ,
influenced Aetna and Pennsylvania Centers for Medicare and Medicaid to change
their reimbursement policies for certain medical procedures. Both patients and
physicians benefit from these reimbursement changes.
The world of medical billing and coding for physician reimbursement is
complex and can be daunting. Staying on top of the game with reimbursement
policies from such large insurance organizations as Aetna, Medicare, and
Medicaid takes knowledge and experience. But sometimes the policies don’t make
sense, are not in the physician’s best interest, or have not changed to keep up
with current medical practices.
That is where a proactive, dedicated, and experienced practice management
company like mpowermed, inc., of Mahwah, New Jersey makes a difference -- by
fighting for every cent due when the polices seem unfair, outdated, or simply
incorrect for today’s needs. Such was the case with a policy regarding a breast
cancer treatment involving a treatment device known as a breast board.
Pennsylvania Medicare and Medicaid were denying payment for more than one use of
these treatment devices a day. mpowermed appealed with the following words in a
letter, “In a given course of treatment, it is most common to see more than a
single treatment device in a day. We are confident that all medical
documentation would prove medical necessity.”
Because of this letter, the Pennsylvania Center for Medicare and Medicaid
Services wrote back to mpowermed saying they researched the treatment device
situation and actually visited a large cancer treatment facility, “to view the
devices and discuss their use and billing with a radiation oncologist.” Based on
these findings, Pennsylvania Medicare and Medicaid will update their policies
regarding this treatment device (CPT Code 77334).
Prior to this victory, mpowermed had written to Aetna about rejecting claims for
another reimbursable item, Portal Film (CPT Code 77417) usage on the same day as
the physician’s weekly management charge (CPT Code 77427). After amassing
impressive documentation proof, mpowermed suggested the changes to differentiate
between portal film usage in a freestanding clinic versus a hospital setting.
Aetna agreed to reimburse the technical use of portal film in freestanding,
privately owned radiation oncology clinics.
According to mpowermed, “It takes patience and perseverance to influence policy
changes in large insurance organizations. Both Aetna and the Centers for
Medicare and Medicaid Services were more than cooperative in affecting the
necessary changes. It is for the benefit of the patient and the physician when
they do! This is what makes medical practice management, billing, and coding
such a rewarding opportunity!”
Company contact:
mpowermed, inc.
June Marshall-Kingsley
Marketing Manager
201-684-1616 Ext. 130
http://www.mpowermed.com
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