ABSTRACT
Some osteopathic physicians are not properly reimbursed by insurance companies after providing osteopathic manipulative treatment (OMT) to their patients. Common problems associated with lack of reimbursements include insurers bundling OMT with the standard evaluation and management service and confusing OMT with chiropractic manipulative treatment or physical therapy services. The authors suggest methods of appeal for denied reimbursement claims that will also prevent future payment denials.
Subject(s)
Fees and Charges , Insurance, Health, Reimbursement , Manipulation, Osteopathic/economics , Musculoskeletal Diseases/therapy , Osteopathic Medicine/economics , Osteopathic Physicians/economics , Forms and Records Control , Humans , Insurance, Health, Reimbursement/economics , Missouri , Musculoskeletal Diseases/economics , Osteopathic Physicians/trends , Practice Management, Medical/economics , United StatesABSTRACT
OBJECTIVE: Our study was designed to document fiscal data for emergency department admissions for acute exacerbation of chronic back pain. DESIGN: This was a 12-month retrospective, descriptive study. SETTING: The two emergency facilities operated by the Maine General Medical Center in central Maine provided the study data. PATIENTS: We collected fiscal data for patients with emergency admissions for acute exacerbation of chronic nonmalignant back pain (International Classification of Disease code 724.1). Data were limited to patients with the top three of five Current Procedural Terminology (CPT) codes visits (99283-99285) for emergency department, indicating problems of moderate to high complexity. Records with event codes (E codes) for trauma and/or malignant disease were excluded. OUTCOME MEASURES: We totaled charges for physician and provider services, laboratory tests, imaging studies, medications, and other billable items. RESULTS: Of 1,397 emergency department visits for acute exacerbation of chronic back pain logged over the 12-month study for all five CPT codes, 1,039 visits were tagged with the three highest codes; 30% were multiple visits. Mean charges per visit ranged from $399 for CPT code 99283 to $1,943 for code 99285. While only 3% of the patients (N=46) were seen three or more times, they accounted for 12.4% of the total charges. CONCLUSIONS: Emergency department care may be a costly venue for the management of chronic back pain. Because most patients obtain only short-term relief, they are likely to continue seeking urgent care intermittently until effective long-term pain management is widely available and reimbursable on an outpatient basis.
