Eli's Rehab Report

Published on Sat Jun 28, 2008 PDF

Want a window into a Medicare contractor's denials for rehab services? You can check out the report Highmark Medicare Services, Pennsylvania's Part B carrier, recently released on its top-10 denials per specialty for 2007.

For the categories of "independently practicing physical therapist" and "independently practicing occupational therapist," most of the top allowed services were the same as the top denied services, which would indicate a natural amount of denials due to the volume of certain claims. Hot-pack applications (97010), however, stood out as one of the top denied procedure for both PTs and OTs -- and did not show up as a top allowed service.

Lesson learned: Even if you don't bill Highmark, be sure to review your coverage determinations for hot packs and other unattended modalities, and make sure your documentation meets all of Medicare's requirements.

To view the full report, go to http://www.highmarkmedicareservices.com/partb/reference/denial-reports/2007/cover.html.