tci Part B Insider - 2006 Issue 6

APPEALS: Claim Denied? Don't Give Up Too Easily

One neurosurgery provider succeeds in convincing payor to cough upJust because Medicare doesn't cover something, you shouldn't assume that other payors will deny it. That's the lesson you can learn from the example of Georgia Neurosurgery in Athens, GA. The Centers for Medicare & Medicaid Services announced in May 2002 that it would no longer pay for operating microscope code 69990 with a laundry list of surgical codes, including laminectomy codes 63030 and 63047--but that didn't stop the Georgia practice from pulling out all the stops for payment.  Since then, carriers, including non-Medicare payors, have denied claims for...

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