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A request for documentation from a Medicare contractor does not have to be daunting to doctors of chiropractic and their billing staff. This checklist breaks down what medical data you need to include to properly respond to a request for chiropractic medical records. The documentation should include, but is not limited to: Patient Information Name […]
The post Responding to a Request for Chiropractic Medical Records appeared first on AAPC Knowledge Center.
I was curious to see if anyone was having issues with United Healthcare with upholding preventative services for medical record request. We bill for Pediatric and Family Medicine we have seen an increase with claims being pended for additional information and to please submit to Optum for review.
My current workflow is to submit the medical records via UHC Link and follow up with Optum directly with the Ticket number to confirm records received and under review. Most cases Optum has received them and will be approved for payment.
However the past month I have had nothing but issues with the Optum in regards to the vaccines/vaccine administration codes/escalated cases/communication back to the claims department.
Optum requires 5 pieces of information in regards to the vaccine details: Vaccine Name, Dosage, Administration Site, Route of Administration and the employee’s name/credentials that provided the vaccine. All of this information is included in our documentation however Optum has still denied stating documentation is insufficient.
Escalated cases sent back for review but often no action is taken.
Optum reviewed medical records and approved line items for payment. However when communication is submitted to UHC claims department only partial claim is paid out or payment is never issued. Therefore I’m having to go back an forth between Optum and the Claims Department and in some case had to have a 3-way call with these departments. Very frustrating to say the least!
For now I have submitted an claim list to our UHC provider rep to get some assistance in regards to our outstanding claims. Is anyone else having issues? If so, please comment as this is an ongoing issue for our practice.
Thank you in advance for any feedback you may have.
If you receive Additional Documentation Requests (ADR) from a Medicare Administrative Contractors (MAC) and others, here are some tips to respond most effectively. Additional Documentation Request Success Isn’t that Hard CGS Administrators, a MAC and Durable Medicare Administrative Contractor (DMAC) with a presence in 38 states, offers helpful tips in their ADR process. ADRs may […]
The post Tips for Handling an Additional Documentation Request appeared first on AAPC Knowledge Center.
thank you
New Jersey
Does anyone know how to make a request for additional digits to be added to ICD-10 codes?
I had hoped the N63 code group would have an addition this fall to include an additional digit of 8 like what we see on the breast cancer codes to allow for coding overlapping quadrant areas, ie. 12,3,6 or 9 o’clock locations. Breast cancer codes allow for use of C50.8– for overlapping sites, however this is not available with the breast mass codes & we do receive denials for use of the unspecified quadrant codes. At this point it does not look like the N63 section codes will change Oct 2018.
Many medical scrubs and nursing scrubs companies have added a new line of scrubs to their collection – men’s scrubs. Nursing Scrubs manufacturers worldwide have received requests from medical personnel around the globe to help men look better at work.
Because medical scrubs retailers should always take into consideration the requests that come in from hospital staff, nurses, doctors, dentists, veterinarians, and anyone in the medical field who is required to wear nursing scrubs and/or medical scrub hats, many small companies have began manufacturing their own medical scrubs. For example, looking at current fashion outside of medicine, a small Austin-based company decided upon a slightly flare-legged, slimming scrub bottom that sat lower on the hips, similar to 7 for All Mankind low rise jeans. Taking into consideration that rarely do women wear jeans with just one pocket in the back, the scrubs company placed two stitched pockets on the backside, which immediately created a leaner look than other scrubs. And, rather than the unflattering elastic waist-band, they added a coordinating ribbon that ties at the waist. Designing the nursing scrub top was simple – a tapered shirt for women always looks better than a boxy shirt, and with one stitched pocket on the upper left-hand side of their flattering scrub top, they released their first line of medical scrubs, now known as Original scrubs. The first color, ceil blue, was so popular that navy, black, and grey were quickly added. While watching many scrubs companies add new colors almost quarterly, men have realized that they were being neglected in medical fashion.
The design process for the specialty men’s medical scrubs took almost a year to complete. But finally, the men’s scrubs bottoms now feature a low rise pant and also are made with the same soft, wrinkle-resistant fabric that is also used for the women’s designer nursing scrubs. With one pocket in the back and a classic white tie in the front, the scrub pants are bound to turn heads. Men may not care for stitching and a tapered top, so the pocket on the top left-hand side of the shirt is sans stitching and the scrub top is not tapered. Even without the stitching, these medical scrubs are still more fashionable than the hospital scrubs that are currently available through other companies. After finally releasing scrubs for men, many nursing scrubs manufacturers found that their fashionable men’s scrubs were out of stock almost immediately. The once small nursing scrubs company wasn’t sure how the line would do once it was made available through the website. However, they began receiving both compliments and requests. Many men have expressed interest in having the custom-stitched pockets, so this is something that may be offered in the future, along with expanding the currently available colors. Grey is the most popular color for men’s scrubs.
The design teams are always working hard, trying to keep up with the demand. Rumor has it that the next product release from small specialty scrubs companies will be a special line of nursing scrubs made specifically from the requests of nurses who love the designer scrubs, but also need strategically-placed pockets at the bottom of the scrub top.
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Thank you for any help and information in advance.