These are additional filing tips in addition to the Reimbursement Checklist. 0.1 Intro In general I have short, one or two-page checklists and then much longer and detailed explainations of nearly everything. Work the checklists first and then look to the Guidebook or the Policy Evaluation Document for more… Continue reading
Below is a valuable list of Gotchas!, Catch-22, Carrier-Specific Rules, and confusing, ambiguous, and contradictory Carrier guidelines and policies. This is kind of advanced but worth your time–especially if denied. I would argue it’s best to review before you file your claim. 1 WHAT IS A GOTCHA! ? A Gotcha… Continue reading
Q: Isn’t Lipedema the same as Obesity? No, it is a condition in which there is a pathological deposition of fatty tissue, usually below the waist, leading to progressive leg enlargement. Lipedema is often misdiagnosed as simply obesity or lymphedema. There is no cure for lipedema and it does not… Continue reading
Expert Opinion Template Sep 28 2020 “Liposuction is an effective treatment for lipedema and has a beneficial effect on net health outcomes based on clinical evidence from well-conducted randomized controlled trials or cohort studies in the prevailing published peer-reviewed medical literature.” Sample Medical Opinion Template Hold Harmless Statement This expert… Continue reading
As a certified medical coder and record auditor I have reviewed over 10,000 medical records in my career. While not a doctor, I have researched hundreds of medical acronyms and medical diagnoses. My focus is slightly different from the physician. I am looking for statements that support the medical necessity… Continue reading
The attached spreadsheet is for the patient to maintain all the information they need to be reimbursed. It is imperative that the patient has everything in order before they contact the insurance company for the pre-authorization. The more documentation you have, and the better it supports the procedure as reconstructive… Continue reading
The Request for Policy Evaluation is a newer document (these were assembled from a variety of sources). I created the policy evaluation and recommend viewing it first and comparing the format and content to the document below and using what you feel pertains best to your specific case. The document… Continue reading
Yes, this is the same Guidebook that is on Amazon.com. It is provided here at no cost to you and in .DOC format so you can copy-and-paste any of into your pre-authorization or appeal document. I am updating it every 4-6 weeks. My goal is to update this document every… Continue reading
Lipedema and Lipolymphedema [Update September 9, 2020 Karen Herbst presented the new codes to the NCHS/CDC committee. The meeting went well and after a public review period it will be determined in early 2021 if they will move forward with the new codes.] Lipedema, initially described at the Mayo clinic… Continue reading
There are over 300 research studies regarding lipedema. There are over forty, peer-reviewed journal articles reviewing the benefits, efficacy, and safety of tumescent, lymph-sparing liposuction as the only surgical treatment for lipedema. For a lay person the most daunting task is knowing which research is considered most scientifically sound and… Continue reading