Medical Claims Appeals
A failure to receive or keep reimbursement, if a consistent enough issue, will threaten the very viability of any medical service. For the comprehensive wound healing center, reimbursement shortcomings can be particularly problematic if hyperbaric oxygen (HBO) therapy changes are involved. This is because the average per-patient charge is very high when compared to any other diagnostic or therapeutic service rendered by the center.
Payment problems can result from several circumstances. It may be that the insurer’s determination that is provided and charged for is not medically necessary. It may be the result of documentation failures or coding errors. It may also be a 'systems error', either within the hospital or by the insurer. And finally, it may be an incorrect insurer determination. Whatever the circumstances, NBS can be instrumental in repairing problems on the provider side and gaining reimbursement where Medicare and other insurance companies are thought to be in error.
For more than a quarter of a century NBS has been actively involved in medical claims billing, reimbursement and the overturning of denials. We have been successful in a very high percentage of cases, particularly those related to the provision of HBO therapy. In particular, we have been completely successful in every Medicare case that was brought before an Administrative Law Judge.
Throughout this period NBS has served in an advisory capacity role on behalf of Medicare and several other purchasers of health care. We have helped them clarify medically necessary policy language, better appreciate supportive science, and better match diagnosis codes to approved indications.
If your wound care and hyperbaric medicine service struggles with reimbursement NBS will likely have the solution.