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Sudden Increase of HCPC E0730 Treatments

S

sahni.vani@gmail.com

Networker
Messages
66
Location
Olney, MD
Hi - I work for an Insurance company ...we are noticing sudden increase in E0730 treatments . What points I shoulder consider before going to Audit the cases
'? 2019 - billed around 100,000 cases but in 2022 they are more than 300,000.

Thanks
Vani
 
There are so many factors that could cause you to see this. I'd suggest you need to do a more in-depth analysis of the data you're looking at. I think the most important thing is not to look just at the total numbers, but to look at the rate at which they are being billed. For example, has your insurance company increased the size of the population that you are covering between 2019 and 2022? If you are covering 3 times as many people, then this wouldn't represent an increase. Or is it just certain providers increasing their billing, or all providers? Is it happening in certain plans or certain localities, or all over? Is it a particular diagnosis that's being treated more often than before? 300,000 cases is too much to audit - I would start narrowing this down to see where the real problem is or might be.
 
thomas7331 said:
There are so many factors that could cause you to see this. I'd suggest you need to do a more in-depth analysis of the data you're looking at. I think the most important thing is not to look just at the total numbers, but to look at the rate at which they are being billed. For example, has your insurance company increased the size of the population that you are covering between 2019 and 2022? If you are covering 3 times as many people, then this wouldn't represent an increase. Or is it just certain providers increasing their billing, or all providers? Is it happening in certain plans or certain localities, or all over? Is it a particular diagnosis that's being treated more often than before? 300,000 cases is too much to audit - I would start narrowing this down to see where the real problem is or might be.
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Thank you for response . I am handling FL cases - Bills are related to Pain Mgmt . I am able to find Incorrect ICD and code being assigned without prescription . I am still looking for more info to Justify an increase . I will look into criteria suggested by you.....hopefully it will take me to a root cause . If anything strikes to you please help......
 
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Hi, I work for insurance also. We have seen an influx of different E codes including this one. I would look at your data and see who are the top billers, have they had a big uptick? What types of providers are billing for these services? Does the member have a claims history where you can see diags related to pain/chiro/pt etc? I would google the top providers and look at what types of services they are providing and then request medical records if your area is allowed to do that. Good luck!
 
patt1018 said:
Hi, I work for insurance also. We have seen an influx of different E codes including this one. I would look at your data and see who are the top billers, have they had a big uptick? What types of providers are billing for these services? Does the member have a claims history where you can see diags related to pain/chiro/pt etc? I would google the top providers and look at what types of services they are providing and then request medical records if your area is allowed to do that. Good luck!
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Thank you ! I will keep in mind the points .
 
Hi - In reference of above issue on sudden uptick E0730 from 2019-2022 ---- Do you think this could be the main issues ...I was able to find many bills with code e0730 under three months of treatments and without certificates.


: "From what I understand from Medicare, you have to show that the patient's pain has been present at least three months and that other appropriate forms of therapy have failed," Management in Clarksville, Tenn. "You also have to have a certificate of medical necessity (CNM) on file and have to enter referring-physician information on the claim."

Thanks
Vani
 
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