Case Studies
New Paint Treatment Therapy Qualifies for Insurance Reimbursements
Their
cutting-edge non-invasive pain
management therapy was approved by the FDA, it didn’t
fall under a specific CPT code.
That meant that physicians had to prescribe the therapy only
to patients who were willing to pay out-of-pocket for this
very effective treatment.
The
pain management therapy founder hired QPS to help consult
with them regarding working on getting an approved CPT code
for the procedure. Understanding the process and length
of time involved in getting new codes approved, QPS took the
initiative to start getting reimbursements immediately by
leveraging the “unlisted procedure codes” for medical billing. Our compliance
department came of with boilerplate rationale to pair
with each submission based on the procedure itself, then tailored
the rationale to the patient’s specific condition.
The rationale demonstrated the efficacy of this non-invasive
therapy vs. a more costly invasive approach, and explained
a subjective pre and post pain inventory from each patient.
While
the practices implementing this procedure were not getting
any reimbursements prior to QPS’s involvement, they
now receive a 75% reimbursement. QPS continues to help
the client work through the process of obtaining a specific
CPT code that will allow them 100% reimbursement in the future.
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