Coding

  • 1.  Simply Healthcare and Florida Medicaid

    Posted 14 days ago
    We are having trouble with denials from Simply Healthcare because of plan limitations on ultrasounds. These limitations don't give us the ability to monitor the patient appropriately and as frequently, like higher risk patients require. These patients in particular tend to require more closely monitored care as it is. So, because we want to provide high quality care and we want to act in the best interest of the patient, we are finding ourselves providing services and ultimately not getting reimbursed for them. Does anyone have any recommendations as far as a way around these limitations?

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    Kasie Patalan
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  • 2.  RE: Simply Healthcare and Florida Medicaid

    Posted 11 days ago
    Hi Kasie,
    If the problem is significant, I would recommend reaching out to the Medical Director and sharing with them guidelines from SMFM and other national organizations in support of your recommendations. Usually they will be receptive to adopting those guidelines and changing their policies to meet them. If not. please let us know by posting your concern at "https://www.smfm.org/coding/payer-questions/new" |.
    Fadi

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    Fadi BSAT, MD, FAIUM
    Past Chair, SMFM Coding Committee
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