Wiki Cahaba Medicare Pre Payment Reviews

[meh]

We are being hit with pre payment reviews for 99233. We have been submitting documentation since July and still claims are not being paid.

Are there any other practices being audited?

Any advice or suggestions would be appreciated.

 

[Walker22]

Is there a particular reason that they aren't paying the claims? There must be some kind of explanation. I would need to know this before I can offer advice

 

[meh]

Cahaba pre-pay review

Received letter yesterday that states no claims have been reviewed and are pending nurse review. Dates of service starting the beginning of July. Letter states we remain under another 90 day prepay review by Cahaba.

Today we did receive some payments and most reduced to 99232, stating done afer a complex medical review. Confused since letter states claims pending nurse review.

My doctor wants to say you win and charge all 99232. I am concerned they will go back and recoup all the 99233 payments.

 

[mitchellde]

It may be in your interest to have a coding expert review the ones they dropped the payment on to see if they can be argued. Most nurses are not coders and are not familiar with the E&M coding guidelines. Also you need to communicate which set of guidelines you used when selecting the visit level, 95 or 97.