Has anyone experienced a issue with a denial from workers comp for going over number of visits BUT staying within timeframe of allowed services? For example; Worker comp allows 2-3 x/week for 6 weeks BUT patient may have been seen 4 times in one week. As well any suggestion on disputing the denial determination with W/Comp....
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Wiki Workers Comp Visits used within weeks of services allowed.
- Thread starter Carolyn CPB CPC
- Start date
daedolos
Expert
3 times a week seems a little excessive. I do know that the form PR2 for reporting is capped off at once a week.
Peace
@_*
Are you saying that all visits were being denied?
Peace
@_*
Are you saying that all visits were being denied?
It is for physical therapy services post surgical; the pt has been being treated for multiple body parts as he was hit by a car while at work. W/C is stating exceed limit of services. Pt needs extensive therapy services. The number of visits frequency apparently was greater than the 2-3 x/week within the allotted number of weeks given.
CodingKing
True Blue
I'm not completely familiar about workers comp, I did have some exposure to my girlfriends disability insurance claim. She was not allowed to go over the 2 visit a week PT max as that was the approved treatment plan. If she wanted more in a week she had to get approved for more than 2 visits a week.
daedolos
Expert
Your best bet is to speak directly with the insurance adjustor. Your best bet to catch that person would be before lunch from Monday through Thursday. I've been handling WC claims for awhile now. These adjustors are sneaky and the companies often change them monthly.
Peace
@_*
Hope this helps.
Peace
@_*
Hope this helps.