beev
Contributor
Any tips for this hearing? I just mailed my request for ALJ yesterday. I rec'd an "unfavorable" decision from QIC who in my opinion didn't even read what I was appealing. We had incorrectly billed a bilateral hip replacement done in the same operating session by two different physicians. Prior to billing this I contacted Medicare and was told to bill the same way they recommend billing bilateral knees in same session by two physicians using modifiers 50 and 62. I have documentation of conversations with 2 different people from WPS telling me this was correct. Come to find out it shouldn't have been billed that way after I spoke with someone teaching a WPS Medicare Seminar, therefore, had to start to "appeal process" I am so frustrated over this and cannot understand why QIC delivered an unfavorable decision stating it didn't support co-surgeons even though I clearly explained the situation to them!