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Thread Title: Med-Legal Billing MRI/Xrays
Created On Wednesday November 19, 2008 8:11 PM


paduanow@yahoo.com
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Wednesday November 19, 2008 8:11 PM

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PTPs are sending us patient for various MRIs. We are billing for Technical and Reading of the MRI results. Doctors writing Med-legal reports based on our services, we believe! The insurance company does not know our services is for a med-legal report when we bill. The PTP gets Preauthorized but we seem to get rejected on our first billing and have to resubmit all the time. We can delay our billing, but we don't really know for how long.

My question:

Is there a modifier I can use to declare our procedure is for Med-legal? Any help?

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steve appell
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Thursday November 20, 2008 10:38 AM

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Your MRI's are treatment, not med legal, and I refer to the following hypo to explain why:

An IW has a broken leg and goes to the hospital for surgery. The surgeon requests an MRI before cutting the patient open to clairfy the damage and plan appropriate treatment. 2 years later, the parties agree to use an AME who requests a 2nd MRI to help determine PD and the amount of calcification prior to the DOI for apportionment purposes. Under this scenerio, the first MRI is treatment because it was used exclusively to treat the patient. However, the second MRI is med legal because it was used to determine contested issues such as PD & apportionment.

Because the MRI was requested by the PTP in your fact pattern, it is treatment and not med legal.

-------------------------
 Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

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paduanow@yahoo.com
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Thursday November 20, 2008 1:13 PM

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Thanks Steve for your answer!

Just one more thing.

I understand that the PTP is sending a ML-103 or ML-102 report which sometimes they attach our reports. I not sure why they attach the report or know the status of the case. But because he needed our report for his ML-0x report it would still not be considered Med legal?

I sound like to me we need to understand better treatment or Med-legal based on a PTP.

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steve appell
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Thursday November 20, 2008 3:05 PM

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Ahh yes........."The AME reviewed my report so it must be med legal."
Also..............."My report was used to settle the case so it must be compensable."
AME's are required to review all reports even in a denied case, and all reports are used by the parties to settle the case. Additionally, when was the last time you EVER saw a med legal report from the PTP indicating the injury was not work related and the treatment was not beneficial?

The fact of the matter is .......If it walks like a duck, talks like a duck, and acts like a duck.............ummmmm well you know the rest.

Good Luck!

-------------------------
 Steve

A government which robs Peter to pay Paul can always depend on the support of Paul.
- George Bernard Shaw

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