We may need to find an actual lawyer to answer this, but I am trying to save the practice money if anyone here knows. There is an exemption in the law for children 14 and up to be able to seek therapy without parental consent, but what does that do with regard to ROIs signed by a parent? There is a situation here with a feuding divorced couple where one parent consents to the therapy( though technically a 14-year-old can go without consent) but doesn’t want treatment notes released even to the insurance company ( which I think doesn’t require consent to get the notes anyway? Though they are auto insurance, as this was related to trauma from an auto accident, rather than a regular health insurer, does that make a difference?) but the other parent is apparently raising a stink about it, trying to convince insurance not to pay, and we have a signed ROI from the objecting parent, but the therapist is not sure what to do and who can have access to this stuff.
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Tag Archives: Exception
Primary Care Exception in Brief
Under the “primary care exception,” a medical resident may perform (and bill for) limited, specific evaluation and management services without the presence of a teaching physician. Here’s what you need to know when reporting these resident services. When the Primary Care Exception Applies Ordinarily, services furnished by medical residents are excluded from Medicare payment because […]
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Exception to G Codes
Can we use something other than a G Code for patients that have commercial insurance, not Medicare, and are over 65? G0438 and 39 are being denied. Maybe a dummy code?
Any help is greatly appreciated!
Any help is greatly appreciated!
Requesting a Policy Exception
Has anyone successfully gotten a policy exception from an insurance company, for additional PT/OT/SLP visits? This would not be an appeal.
It is a Premera Plan in Washington state. The policy very clearly has a 14 visit combined cap and between the 3 disciplines, we’ve hit the cap already. I realize there is no reason to appeal the future denied claims, because the denial is valid. There is nothing to argue.
For this patient, a child with Down Syndrome, 14 visits isn’t nearly enough to make any progress.
Does anyone have any tips for how I can make this happen? I know policy exceptions are generally for Drugs and out of network services.
Apply Here for MIPS Hardship Exception
The Quality Payment Program Hardship Exception Application for the 2017 performance year is now available on the Quality Payment Program website. Determine if You Are Exempt Clinicians who are eligible to participate in the Merit-based Incentive Payment System (MIPS) this year, but are not able to fulfill the Advancing Care Information performance category, for one […]
AAPC Knowledge Center