Medical Billing Forum

Payments => Insurance Payments => Topic started by: DMK on September 21, 2010, 12:59:27 PM

Title: Unit reduction
Post by: DMK on September 21, 2010, 12:59:27 PM
Do the insurance companies have the RIGHT to reduce the number of units of physical therapy billed? 

Certain Blue Cross and Blue Shield Plans have started to reduce the units of physical therapy to 1 automatically.  I have re-submitted to B/S with documentation showing that we are working on multiple areas and have been successful in getting the additional units paid about 75% of the time.  We are now getting denied more often.

The particular Blue Cross has stated outright that only 1 unit of a particular range of services will be allowed.

Any thoughts?
Title: Re: Unit reduction
Post by: Michele on September 22, 2010, 06:52:18 AM
I have had our local BC reduce the number of PT units, but when we submit a request for reprocessing they always honor it.  They call it a 'glitch'.  Personally I wonder how many PT offices have staff that don't know what to do so they accept the payment.  Anyway, ours only happens once in a while, so it's not a big deal.  If it were happening more often I would contact our provider rep and have them do something to correct the situation.