Enough With the Hearsay: Take Time to Verify

Home > Articles > Enough With the Hearsay: Take Time to Verify
By Erin Cammarata

Janet told me that those ankle joints are never covered." "I was always told Medicare will not pay for unlisted (999) procedure codes." "We need two people for that job."

These comments are from actual conversations I had this week. The thing is, they are all false but were believed and accepted as fact because someone said so. I'm discovering that most people will generally accept whatever someone tells them because it's easier than looking it up, but most of these can be checked pretty quickly.

Well, enough with the hearsay. It is time to get the facts, read the policies, and ask for references on the information you are receiving. Too often the person who told you the answer heard it from someone else. Don't make decisions based on legend.

Those ankle joints that someone said were never covered are in fact payable, clinically effective, and the best option for the patient. This information could have been found by researching the correct procedure code and the details in the patient's insurance policy.

Ensure that your staff has the proper credentials to use the online portals to access this information. I have said this before, research and access to the patient's direct policy is imperative to supplying the right items and fighting for payment. You simply can't do this job without it.

I have heard so many times that Medicare will not pay for 999 codes, and it is not true. Too often I find it is an excuse to not work a bit harder to get that claim paid. If a code that accurately identifies the procedure performed or device provided doesn't exist, it the provider's responsibility to provide the information that is needed to process that claim correctly. The procedure for billing for an unlisted or not otherwise classified (NOC) code is available online. You can read Noridian's Jurisdiction D instructions at bit.ly/3gtq2rn. For payers other than Medicare, review your contracts to find the specifics of that policy's 999 procedure codes. I learned earlier this year that Medicare reimbursements for unlisted O&P codes exceeds 1 million dollars annually.

That third comment, "We need two people to do that job," came during a phone call with a client. The job in question was for a specific task that was limited in scope. When I asked why she felt she needed two people, the answer was that that's what the staff asked for. There was no investigation into the details of the task or the actual time it would take to complete it. The decision to hire two people was based on hearsay. When the client and I broke down the process and established how much time every component of the job should take, we determined that it would require six hours per week.

So when you ask others for information, remember to ask why, and also ask for the reference.

Now don't go take my word for it, look it up yourselves.


Erin Cammarata is president and owner of CBS Medical Billing and Consulting. She can be contacted at erin@cbsmedicalbilling.com.