Billing Templates, Instructions & Supporting Documents
Making Your Work Easier
Parallel to the technical development of the Reltok Clear-Flo Nasal Airway, we have developed detailed content to “copy and paste” into the surgeon-dictated op report by the transcription service. That portion of the op report supports the “30999-59 by report” procedure code. We paid attention to proper completion of the HCFA-1500 billing form, particularly “Line 19”, which directs the claim processor to that airway verbiage within the op report and also notes that the device is “FDA-cleared”.
Next, we created a, photo-illustrated Claim Appeal Letter which includes every possible support documentation including the FDA clearance letter and the device’s patent identification. The appeals form became unassailable.
Remember, you are not begging to be paid; you are ordering them to pay you because you have the force of the state regulations precedent behind you. Employ a courteous but strong form letter.
Finally, in all fairness to insurers, not every delay or denial represents an exercise in cheating. Often, insurance company claim processors, inadequately trained in the processing of claims, particularly “30999-59, by report”, may just hit the “Deny” button because it is the quick and easy way out. Perhaps they don’t take the time to read the op report and collateral material because they are under pressure to process “X” number of claims per hour.
MDs are held to high standards. Why not insurers? Demand excellence and accuracy!