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
What you must do: We are assuming that you’ve passed the approval hurdle, the surgery has been deemed to be reconstructive and medically necessary and not cosmetic. You have also discussed the number of procedures required (typically at least two, depending on severity). Often the insurance carrier will assign the… Continue reading
After accumulating hundreds of pages of information on how to be reimbursed for liposuction for lipedema, we now has the issue of “how insurance-friendly” is your chosen surgeon.” There is additional information on all of the specific terms in this article on this website. If you download the one-page checklist… Continue reading
A patient advocate assists with getting a patient paid on difficult or unusual cases. Liposuction for Lipedema fits this category well–some are paid with little effort while others may take multiple appeals. While there are numerous consumer/patient medical reimbursement advocates there are few who are familiar with liposuction for lipedema…. Continue reading
Below is a sample letter to request a Reimbursement Policy Evaluation for Liposuction for Lipedema. While this example is Noridian Medicare, it can be used for any carrier. Just change the name and if they have any information in their manual I would add that as well. There are a… 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
The most common claim form is the CMS-1500 form. This is what medical clinics use for professional services. (A hospital bills on a separate form, the UB-04). If you work out a Single Case Agreement (SCA) with and insurance company you will fill out the CMS-1500 form. Below are files… 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
This varies by insurance company. Each one is different but common periods are 90, 120, 180, and 365 days. If the insurance company does not receive your claim within their period it will be denied and you will be responsible for all charges. This has nothing to do with any… Continue reading
This is another one-page graphic–everything on one page with concepts, specific items, and their relationship to one another all on one page. It is very useful for group meetings with high-level management–as well as clinical people. The detail is in my Reimbursement Guidebook; a one-page checklist is also available on… Continue reading
Simply calling the procedure liposuction for lipedema misses the complexity of the procedure, the additional time, and the expertise required to perform it safely. The one thing it should never be called is “cosmetic” or “aesthetic” liposuction. The procedure has many names, including: Tumescent Liposuction Tumescent Local Anesthesia (TLA) Lymph-Sparing… Continue reading
Recorded PowerPoint Presentation by Jeffrey P. Restuccio, CPC, COC, MBA, reimbursement expert, certified medical coder and auditor. Please share this presentation with Providers, associations, blogs, researchers, and patients. A PDF of the presentation is at the link below:
I’ve been contacting researchers,surgeons, associations, and patients for months and providing up-to-date and accurate information on how to be reimbursed by insurance companies for liposuction for lipedema. The question I get most often is, “How can I help? What specifically do you want me to do?” So here is the… Continue reading
After several months feedback has been to simplify, simply, and SIMPLIFY! I’ve updated the checklist (Aug 14, 2020). I now have a one-page concise version plus a longer, three-page version. The guidebook will be updated shortly in Aug 2020 and is now over 50 pages. While personally I think all… Continue reading
I encourage all doctors and associations to add, at the very least, the following single sentence to their website or blog (patients please share this with everyone who cares as well as your doctor; it can make the difference between reimbursement and a denial): There are two kinds of liposuction:… Continue reading