Five Steps to Appeal Common Neurology Practice Denials
Published on Mon Jan 01, 2001
Insurance denials for services provided are a frequent occurrence for neurology practices, many of which spend hours each week appealing these claims.
For example, practices that track common denials and speak directly with claims managers will most likely make better use of their time and gain denied monies than those who send standard appeal letters with a copy of the patient chart.
A recent survey of Neurology Coding Alert subscribers indicates that frequent denials occur when billing for 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) and/or 95903 (with F-wave study) on a consistent basis whenever they are reported together for the same patient, even if the studies were performed on different nerves.
The following tips should help neurology practices deal more effectively with appeals:
Step One: Know Your Insurers Appeals Method
According to L. Michael Fleischman, CPC, principal of Gates, Moore & Company, a healthcare consulting firm in Atlanta, many practices arent familiar with their insurers appeals guidelines. The insurance companys provider manual should spell out very specifically what the method is for appealing claims. The appeal process may be different for each carrier, and should appear in the provider manual.
Some independent payers have shorter time limits (60 days) to file an appeal than Medicare (six months). All non-Medicare carriers follow a more informal appeal process than Medicare because none have an administrative law judge level of appeal.
Sometimes it is sufficient to correct the coding and resubmit the claim, saving time and effort. Some carriers want corrected claim written in red in the upper right corner of the HCFA-1500 form before resubmission so they know to offset any amount previously paid.
Step Two: Ensuring Accuracy on Your Side
Many denials can stem from errors within your own practice, says William J. Mazzocco Jr., PA-C, RN, president of Medical Administrative Support Services, a healthcare consulting firm in Altoona, Pa. Simple things like forgetting a modifier can result in denial, so its important to review the patient information in your office before you begin any appeal process.
For example, a neurologist performs a new patient office visit (99201-99205) and decides to perform a lumbar puncture (62270) on the patient on the same date of service. When billing, if the neurologist forgets to attach modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code, the E/M would not be reimbursed.
Mazzocco suggests that practices review patient information to ensure that facts such as procedure codes, diagnosis codes and modifiers are correct, and that the claim was sent to the correct insurer. For example, if Medicare [...]
