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
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
Recommended updates to the lipedema.org coding page Aug 19 2020. https://www.lipedema.org/about-lipedema The information on the www.lipedema.org web page (Aug 19, 2020) is confusing and incorrect. Please see the update below. On June 12, 2020 an ICD-10-CM evaluation committee, headed by Dr. Karen Herbst with support from the American Vein and… 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
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
FOR IMMEDIATE RELEASE June is National Lipedema Awareness Month Memphis TN, June 12, 2020 Lipedema is often misdiagnosed as obesity, edema, or lymphedema. While all can be present with lipedema, it is a separate condition. When lymphedema occurs with lipedema it’s known as lipolymphedema, a secondary lymphedema. To accurately diagnose… Continue reading
The information below would be of most interest to those performing liposuction for lipedema, and in particular those who are interested in obtaining carrier reimbursement for the procedure. Please see my other posts concerning reconstructive versus cosmetic and medical necessity for coverage of those important reimbursement issues. The information below… 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
Below is a list of terms, phrasing and supporting research you can include in your pre-authorization or appeal documentation package as appropriate: Medically effective FDA approved equipment Conclusions…the effect of the intervention on health outcomes Make argument …that measurement(s) or alteration affects health outcomes Safe or effective Exceeding the outcome… Continue reading
The most recent Excel version of the checklist is above. 1 Liposuction for Lipedema Reimbursement CHECKLIST. Asterisk * [right] means additional information is available on www.lipoforlipedemareimbursement.com [December 2, 2020] Check website for updates.2 Make a decision for surgery (in the future). [Website www.lipoforlipedemareimbursement.com]3 Review your insurance policy for coverage information…. Continue reading
Below I reviewed ten Experimental/Investigational (E/I/U) healthcare policies. The goal here is to compare and contrast them. While very similar, there are differences in the definitions, requirements, and restrictions. I have emphasized issues and terms I consider important. Remember my mottos: Words matter Specificity matters Dates matter Accuracy matters Tailoring… Continue reading
This term has different means depending on its usage. Many are inter-related. Clinical: It refers to whether treatment of a disease or condition is warranted medically. This is in regard to published Clinical Practice Guidelines (CPGs) for care for a particular condition. There are clinical guidelines for many conditions including… Continue reading