I do billing for a physician that is specializing in physical medicine and rehabilitation. We bill for Facet Injections, Epidurals, Neurolysis, Trigger points etc. The last 2 months we have had some issues with Aetna Insurance Company (we are located in florida) requesting medical documentation on every single claim we have billed, except a stand alone office visit. Back in May there was a change in the facet injection guidelines, nothing states they will be requesting notes on every claim. Also we recevied a letter from Aetna stating there is a new claims review process being introduced in March 2010. Orthonet (a musculoskeletal benefits management company) will be conducting a pre-payment review of "selected" clinical services. As a component of this program, we MAY request medical records to compare to clinical coding submitted on the claim to the corresponding clinical services that you provided.
When we contacted our provider rep, we were told that yes all claims would need to have medical records. (all claims for procedures billed other than office visit codes) Nothing states anywhere where this is correct. I have pages of unpaid claims requesting medical documentation, and she doesnt seem to understand why our office is a little confused. Is anyone else having this issue with Aetna? Also is this correct that we would send every single procedure claim with medical records? Which would be more than half of my claims billed. Please help!! I am getting no where with my provider rep.
Thank you!! Jaymie
When we contacted our provider rep, we were told that yes all claims would need to have medical records. (all claims for procedures billed other than office visit codes) Nothing states anywhere where this is correct. I have pages of unpaid claims requesting medical documentation, and she doesnt seem to understand why our office is a little confused. Is anyone else having this issue with Aetna? Also is this correct that we would send every single procedure claim with medical records? Which would be more than half of my claims billed. Please help!! I am getting no where with my provider rep.
Thank you!! Jaymie
