Posts

Congratulations!

This month’s AAP News has some great news and some congratulations are in order to some PCC friends and family. First, Dr. Richard Tuck won the District V Vice Chairperson position. Wow! I can’t think of a better person to lead a district. Second, Dr. Phyllis Cavens won the 2007 AAP Local Heroes award. To …

AAP NCE and Dinner

At the annual AAP NCE meeting in SF next week, we’ll be eating and drinking a lot as usual. We’d – and I! – would be delighted to see you if you’re there. Even better, if you’re a SOAPM member, make sure to come to the (now) annual SOAPM “informal” gathering. Below, please find two …

92586/7 (Hearing Screen) and UHC – Clarification

I don’t think this is archived on the AAP WWW site, yet, but the Private Payor Advocacy group just released the following: 1. Clarification on UnitedHealthcare (UHC) audiological and vestibular function testing policy As reported in its September Network Bulletin, UHC is dropping CPT code 92587 (Evoked otoacoustic emissions; limited (single stimulus level, either transient …

UHC and Synagis

From a few places, including SOAPM: There are rumors floating around that UHC will not approve Synagis this year for any babies 32-35 weeks regardless of their current age or risk factor status (against current AAP recommendations). Surprised? No. UHC will continue to behave this way until it becomes worthwhile for them to stop (and …

Vaccine Showdowns (Go EBP!)

My apologies to the readers of the SOAPM mailing list, as this is a repeat, but there are too many folks who would otherwise miss this piece from the San Francisco Chronicle: Doctor-insurer disputes force parents to pay up front for shots It’s the children who feel the sting of vaccinations, but it’s their parents …

-25 Modifier Data

Another scoop for the blog.  Pediatric benchmarks regarding the use of -25 modifers. This is part of the quick examination the AAP asked us to do.  Ultimately, they are trying to determine whether improper payment for -25 modified codes should take priority over immunization admin codes or not.  Tough call, though I lean toward the …

Not Making the Grade

I picked up this tidbit from a message forwarded to PedTalk (thanks, Dr. Gewanter). Family Practice Magazine and the associated AAFP (from whom the AAP is finally starting to learn!) “…decided last year to conduct a Consumer Reports-style survey of physicians’ experiences with third-party payers.” The results are hardly surprising. OK, I was surprised that …

Imms Admin (90465 vs. 90471)

For some time, we have known that our customers who use the “new” imms admin codes tend to get paid better for them. We figure, just as Dr. Bradley stated at the PCC-sponsored Coding event in NYC recently, that many of the MCOs simply entered the new codes with the new values but didn’t update …

Back To The Mothership

Whew, I am finally back from a whirlwind tour and Vermont hasn’t looked this good in a long time. During my travels, I have had over a dozen new insurance updates/stories/foibles forwarded to me, 90% of them originating with United Health Care. I’ll toss some up, of course. I can’t wait for United to find …

Pediatric Benchmarks I

Sorry for the delays – a busy Users’ Conference, some great family camping, and prep for an AAP coding event, and a guy gets distracted! I have grand plans for a series on pediatric benchmarks. Igor and I have been working feverishly on a series of WWW-based tools for our clients and our hands are …