RE: Neuromuscular Re-ed and BCBS of Tennessee

[Guest guest]

Meryl-

We are in Western NC and unfortunately deal with BCBS of Tennessee quite

frequently. They have not covered neuromuscular re-ed for some time.

It is very frustrating but our therapists are aware and do not charge it. If you

feel motivated and want push it with them, maybe we could work together to give

them some alternate evidence to consider...

Jeanne Bradshaw, PT, OCS

Director of Rehabilitation Services

Appalachian Regional Healthcare System

phone

fax

P Please consider the environment before printing this e-mail

From: PTManager [mailto:PTManager ] On Behalf Of

Freeman, Meryl

Sent: Tuesday, October 25, 2011 9:36 AM

To: 'PTManager '

Subject: Neuromuscular Re-ed and BCBS of Tennessee

Hello group,

We have a patient here in NC who has BCBS of Tennessee through and employer. She

had a long and complicated recovery from necrotizing fasciitis. BCBS of

Tennessee is denying all charges of neuromuscular re-ed (97112) saying it is

investigational. Whaaaaat???? Here is the link to the policy. Anyone have any

experience with this? The references at the bottom of the page are, shall we

say, interesting.

http://www.bcbst.com/mpmanual/!SSL!/WebHelp/Neuromuscular_ucation.htm

Meryl W. Freeman, MS PT

Manager, Rex Hospital Outpatient Rehab

2709 Blue Ridge Road, Suite 200

Raleigh, NC 27607

(office)

(cell)

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[Guest guest]

That sounds like a plan. We don't normally see many of these patients, and this

is the first we have seen of a denial for 97112. I guess the question is, what

do you bill? If you are doing neuromuscular re-ed (balance, etc), shouldn't you

bill for what you do?

I find it odd that Medicare/Medicaid and all other payers will pay for

neuromuscular re-ed. I hope this is not a trend....

Meryl Freeman MS PT

Manager, OP Rehab

Rex Healthcare, Raleigh, NC

From: PTManager [mailto:PTManager ] On Behalf Of

Jeanne Bradshaw

Sent: Tuesday, October 25, 2011 10:54 AM

To: PTManager

Subject: RE: Neuromuscular Re-ed and BCBS of Tennessee

Meryl-

We are in Western NC and unfortunately deal with BCBS of Tennessee quite

frequently. They have not covered neuromuscular re-ed for some time.

It is very frustrating but our therapists are aware and do not charge it. If you

feel motivated and want push it with them, maybe we could work together to give

them some alternate evidence to consider...

Jeanne Bradshaw, PT, OCS

Director of Rehabilitation Services

Appalachian Regional Healthcare System

phone

fax

P Please consider the environment before printing this e-mail

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf

Of Freeman, Meryl

Sent: Tuesday, October 25, 2011 9:36 AM

To: 'PTManager <mailto:%27PTManager%40yahoogroups.com>'

Subject: Neuromuscular Re-ed and BCBS of Tennessee

Hello group,

We have a patient here in NC who has BCBS of Tennessee through and employer. She

had a long and complicated recovery from necrotizing fasciitis. BCBS of

Tennessee is denying all charges of neuromuscular re-ed (97112) saying it is

investigational. Whaaaaat???? Here is the link to the policy. Anyone have any

experience with this? The references at the bottom of the page are, shall we

say, interesting.

http://www.bcbst.com/mpmanual/!SSL!/WebHelp/Neuromuscular_ucation.htm

Meryl W. Freeman, MS PT

Manager, Rex Hospital Outpatient Rehab

2709 Blue Ridge Road, Suite 200

Raleigh, NC 27607

(office)

(cell)

----- Confidentiality Notice -----

This e-mail and any attached documents contain confidential information

belonging to the sending entity, Rex Healthcare, and is intended only for the

use of the individual(s) or entity(s) associated with the recipient addresses

listed in the message header. The authorized recipient of this information is

prohibited from disclosing this information to any other party. If you are not

the intended recipient, you are hereby notified that any disclosure, copying,

distribution or action taken in reliance on the contents of the email and/or

attachments is strictly prohibited. If you received this e-mail transmission in

error, please notify the sender immediately to arrange for return or

destruction of this information.

To report abuse or inappropriate use, please email

abuse@...<mailto:abuse%40rexhealth.com><mailto:abuse%40rexhealth.com>.\

(

[Guest guest]

That sounds like a plan. We don't normally see many of these patients, and this

is the first we have seen of a denial for 97112. I guess the question is, what

do you bill? If you are doing neuromuscular re-ed (balance, etc), shouldn't you

bill for what you do?

I find it odd that Medicare/Medicaid and all other payers will pay for

neuromuscular re-ed. I hope this is not a trend....

Meryl Freeman MS PT

Manager, OP Rehab

Rex Healthcare, Raleigh, NC

From: PTManager [mailto:PTManager ] On Behalf Of

Jeanne Bradshaw

Sent: Tuesday, October 25, 2011 10:54 AM

To: PTManager

Subject: RE: Neuromuscular Re-ed and BCBS of Tennessee

Meryl-

We are in Western NC and unfortunately deal with BCBS of Tennessee quite

frequently. They have not covered neuromuscular re-ed for some time.

It is very frustrating but our therapists are aware and do not charge it. If you

feel motivated and want push it with them, maybe we could work together to give

them some alternate evidence to consider...

Jeanne Bradshaw, PT, OCS

Director of Rehabilitation Services

Appalachian Regional Healthcare System

phone

fax

P Please consider the environment before printing this e-mail

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf

Of Freeman, Meryl

Sent: Tuesday, October 25, 2011 9:36 AM

To: 'PTManager <mailto:%27PTManager%40yahoogroups.com>'

Subject: Neuromuscular Re-ed and BCBS of Tennessee

Hello group,

We have a patient here in NC who has BCBS of Tennessee through and employer. She

had a long and complicated recovery from necrotizing fasciitis. BCBS of

Tennessee is denying all charges of neuromuscular re-ed (97112) saying it is

investigational. Whaaaaat???? Here is the link to the policy. Anyone have any

experience with this? The references at the bottom of the page are, shall we

say, interesting.

http://www.bcbst.com/mpmanual/!SSL!/WebHelp/Neuromuscular_ucation.htm

Meryl W. Freeman, MS PT

Manager, Rex Hospital Outpatient Rehab

2709 Blue Ridge Road, Suite 200

Raleigh, NC 27607

(office)

(cell)

----- Confidentiality Notice -----

This e-mail and any attached documents contain confidential information

belonging to the sending entity, Rex Healthcare, and is intended only for the

use of the individual(s) or entity(s) associated with the recipient addresses

listed in the message header. The authorized recipient of this information is

prohibited from disclosing this information to any other party. If you are not

the intended recipient, you are hereby notified that any disclosure, copying,

distribution or action taken in reliance on the contents of the email and/or

attachments is strictly prohibited. If you received this e-mail transmission in

error, please notify the sender immediately to arrange for return or

destruction of this information.

To report abuse or inappropriate use, please email

abuse@...<mailto:abuse%40rexhealth.com><mailto:abuse%40rexhealth.com>.\

(