Hi Ron: I do apologize for the late post but yes...way to go, congratulations!!!!
I believe that it was probably an LMRP issue with your local intermediary/ carrier. I have always been reimbursed for my evals in ALFs. My intermediary is Adminastar / carrier is PGBA. With your work, states that are similarly effected as yours must seek a revision of the LMRP to allow 97003. I did face this problem with some private insurance (can't recall which one). They covered other codes but not an OT eval. I stayed quite because I got the rest paid and didn't want the hassle. But next time I will not give in. Joe ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: "Lehman, David" <[EMAIL PROTECTED]> Sent: Tuesday, March 30, 2004 8:20 AM Subject: Re[2]: [OTnow] GREAT NEWS! > Hello David: > > Thanks for the 'thanks'. Why is it that a PT is the ONLY person to have > responded to the message??????? People in my profession can be such > weinies.... Don't they even care about stuff like this..... I get so > frustrated with being an OT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! > > > What's happening with you???????????? > > > Ron > > ================================================================= > > On Tuesday, March 30, 2004, you wrote: > > LD> You go Ron.....just saw this post and thought I would congratulate you > LD> on getting somewhere with the gov't:) > > LD> Hope you are well. > > LD> David A. Lehman, PhD, PT > > LD> Associate Professor > > LD> Tennessee State University > > LD> Department of Physical Therapy > > LD> 3500 John A. Merritt Blvd. > > LD> Nashville, TN 37209 > > LD> 615-963-5946 > > LD> [EMAIL PROTECTED] > > > LD> -----Original Message----- > LD> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On > LD> Behalf Of Ron Carson > LD> Sent: Monday, March 29, 2004 7:21 PM > LD> To: [EMAIL PROTECTED] > LD> Subject: [OTnow] GREAT NEWS! > > LD> Hello: > > LD> A while back, I ran into a Medicare situation where my company was > LD> unable to > LD> receive payment for OT evaluations provided at assisted living > LD> facilities. > LD> The problem had nothing to do with my company, but it was a Medicare > LD> policy > LD> that did not allow procedure code 97003 (OT eval) to be billed at an > LD> ALF > LD> place of service. I was very disappointed in this policy > LD> because it > LD> effectively prevented me from seeing clients in ALF's. It was > LD> particularly > LD> disappointing because, procedure code 97001 (PT eval) was reimbursable > LD> at an > LD> ALF. > > LD> So, after several long conversations with Medicare, I was given an > LD> e-mail > LD> address in which to address my inquiry as to why OT could not be > LD> reimbursed > LD> for procedure code 97003. > > LD> After several weeks, I received the following message: > > >> Dear Mr. Carson, > > >> I was assigned your correspondence originally dated 1/29/04, > LD> regarding > >> billing 97003 in an ALF. This is an appropriate place of service > LD> for > >> 97003. I will have a system change request done to have an ALF > LD> added to > >> the system to allow code 97003. I will let you know the effective > LD> date, > >> once I have one. Thank you, Diane > >> > >> Diane Prevatt, RN, BSN > >> Medical Policy and Procedures > >> First Coast Service Options, Inc. > > LD> I just found out today, that it is now effective that procedure code > LD> 97003 > LD> can be billed at ALF's. > > LD> Now, I wonder if it can be this easy to get Medicare to let OT open > LD> home > LD> health cases!! > > LD> Ron > > > > > LD> _______________________________________________ > LD> To unsubscribe, visit: > LD> http://otnow.com/mailman/listinfo/otlist_otnow.com > > LD> The OTnow Mail Archive: > LD> www.mail-archive.com/[EMAIL PROTECTED] > LD> =============================================== > > > > LD> _______________________________________________ > LD> To unsubscribe, visit: > LD> http://otnow.com/mailman/listinfo/otlist_otnow.com > > LD> The OTnow Mail Archive: > LD> www.mail-archive.com/[EMAIL PROTECTED] > > > > _______________________________________________ > To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com > > The OTnow Mail Archive: > www.mail-archive.com/[EMAIL PROTECTED] > =============================================== > _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
