Payer Policy is Important

by 
August 10th, 2015

I attended the 2009 AAPC (American Academy of Professional Coders) convention in Las Vegas. Perhaps the most valued lesson relearned there was from Mike Miscoe, CPC, JD. Yes, he is a certified professional coder and an attorney. Mike is one of the most knowledgeable consultants in health care reimbursement that I know. His breakout session was on Physical Medicine therapies, which are commonly used by most doctors of chiropractic (as well as PTs and DOs). I relearned the hard realities of payer policy. Just because a procedure has a code, it does not imply any permission or rights to use it, unless it is in your scope of practice license and covered in the payer’s policy.

Being Clueless Gets a Ticket - On the way home to Phoenix from the AAPC convention in Las Vegas, I passed through our beautiful Southwest desert. I had the cruise control on (my safeguard against speeding in my red car, and to save gas). So, when I drove by the police car on the side of the road with his flashing lights (for someone else), I felt smug and breathed a sigh of relief. However about a minute later he was on my tail with his flashing red lights. After I rolled down the window, and looking at my license, he asked, “Mr Leavitt, do you know why I stopped you?” I responded with a puzzled and questioning look and said, “Officer, I don’t have a clue.” He then explained the new law of moving to the left/outer lane (if there is one), leaving ample space between a parked emergency vehicle with flashing lights and the moving traffic

He had mercy and only gave me a warning ticket. He got credit for doing something (education) for his daily report and salary. I had violated the law in ignorance. What a nice officer. I shall long remember him.

It all caused me to ponder about our good doctors who are sometimes ignorant of all their various payer payment rules. Sometimes their payments are also “stopped”. Like me, many seem to be “clueless” about why they got the “red lights.” It confirmed in me the desire and passion to help our ethical doctors to know all the rules on how to get paid. It can be comforting to cruise on down the payment road but only with knowledge.