I received the following message from my Medicare intermediary. I had asked them about Joe's observation (quoted below). Joe is correct!!!
J> Ron, J> For many services/procedures (unless there's national guidelines), it is J> up to the Carrier and/or Intermediary on coverage and how to administer J> the Medicare contract. Therefore, it is possible that some J> services/procedures are covered in one part of the country and not the J> other. It is unclear as to why this Carrier chose to not allow this J> service (97003) in this place of service (ALF); however, effective for J> claims processed on or after 3/23/04, this service is allowed in an ALF. J> I hope this information is helpful. Thanks, Diane ================================================================= On Tuesday, March 30, 2004, you wrote: J> Hi Ron: J> I do apologize for the late post but yes...way to go, congratulations!!!! J> I believe that it was probably an LMRP issue with your local intermediary/ J> carrier. I have always been reimbursed for my evals in ALFs. My intermediary J> is Adminastar / carrier is PGBA. With your work, states that are similarly J> effected as yours must seek a revision of the LMRP to allow 97003. I did J> face this problem with some private insurance (can't recall which one). They J> covered other codes but not an OT eval. I stayed quite because I got the J> rest paid and didn't want the hassle. But next time I will not give in. _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
