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CodeMap Compliance Briefing: 01/21/05


 

Editor's Welcome

A number of our readers have emailed and called concerning a problem they are experiencing with their Medicare Carrier or Fiscal Intermediary. The problem is that some Medicare contractors are denying claims for venipunctures when the blood draw is reported with CPT code 36415. Even though 36415 is clearly the appropriate code since January 1, 2005, these claims result in inexplicable denials. This problem illustrates the importance, and sometimes necessity of the Medicare appeals process. The appeals process has changed considerably during the past year so over the next two weeks we will discuss these new and revised procedures and how Medicare must respond.  As always, keep those questions and comments coming.

Sincerely,

Charles Root, Ph.D.

Appealing Medicare Claims Denials

Once an initial claim determination is made, providers may have the right to appeal. This right generally depends on whether the claim was assigned or unas....

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