Cassi3434
Contributor
We have noticed UMR will void codes submitted for prior authorization stating "Included with Primary Code Review".
Example: We submit authorization for 97162, and 97110. They void the authorization on 97162 and approve 97110 (Therapeutic exercises). CMS allows payment on both codes, but UMR is telling us to only bill 97110 and not 97162, even though no TE was performed on that date. That seems like fraudulent billing to us.
Is anyone else seeing this? Is there a policy they are referring to that I'm not seeing? We have called and keep getting the run around. We have been appealing the denials, but the appeals are denying as no auth. Any insight helps!
Example: We submit authorization for 97162, and 97110. They void the authorization on 97162 and approve 97110 (Therapeutic exercises). CMS allows payment on both codes, but UMR is telling us to only bill 97110 and not 97162, even though no TE was performed on that date. That seems like fraudulent billing to us.
Is anyone else seeing this? Is there a policy they are referring to that I'm not seeing? We have called and keep getting the run around. We have been appealing the denials, but the appeals are denying as no auth. Any insight helps!