APMA News - July/August 2018 - 25
Reimbursement
Lastly, if you believe the service you provided is reasonable,
you should always appeal, all the way to the ALJ when it is
Medicare, or to a private carrier's highest level when it is based
on anatomical variance. You would make the case that while
these edits exist, you did not perform the service on the same
anatomical site, let alone the same anatomical extremity. In the
example above, if one fusion was performed on the right great
toe and one was performed on the left great toe, the edit is
unreasonable. If you can prove your case that there was an independent symptom, illness, or injury, and clearly these conditions are anatomically distinct, you should be able to prevail
and ultimately get paid for your service(s). Please note that an
appeal to an ALJ could take two years or more, and there is the
possibility you might not win.
Certain codes have limits that one could agree are fair in
some cases; however, other codes have edits that are impossible to accept. The APMA Coding Committee discussed these
limitations at its May meeting and is trying to work with CMS
to change some of the limitations imposed on codes for which
the edit number is unreasonable.
n
For questions about any of these issues, contact the
Health Policy and Practice department at healthpolicy.
hpp@apma.org.
Did You Know
APMA offers discounts on
services from companies
like Bank of America,
Lenovo, and others?
Visit www.apma.org/save
for details.
APMA Committee Nominations Requested
Looking for a way to be more involved with APMA?
Submit your name for consideration to serve on an APMA committee.
APMA President-Elect David G. Edwards, DPM, is requesting nominations for APMA board committee assignments. Assignments will become effective at the close of the
2019 House of Delegates on March 18.
Requests for assignments should include a list of speciļ¬c
committees and a list of general areas of interest and expertise.
If you are an incumbent on a committee and are interested in continuing to serve, you do need to indicate your
interest by sending a letter indicating preferences and current
curriculum vitae to:
Stephanie Simmons
Senior Executive Administrator
APMA, 9312 Old Georgetown Road
Bethesda, MD 20814
or srsimmons@apma.org
and
David G. Edwards, DPM
APMA President-Elect
1651 Saddle Hill Dr.
Logan, UT 84321-4828
or dgedwards@apma.org
Information regarding the charge of each committee is
available on the APMA website (www.apma.org/committees);
hard copy available upon request. Questions should be directed to the senior executive administrator. The deadline
to submit nominations is September 1, 2018.
APMA News July/August 2018
25
http://www.apma.org/save
http://www.apma.org/committees
Table of Contents for the Digital Edition of APMA News - July/August 2018
Contents
APMA News - July/August 2018 - Cover1
APMA News - July/August 2018 - Cover2
APMA News - July/August 2018 - 3
APMA News - July/August 2018 - 4
APMA News - July/August 2018 - 5
APMA News - July/August 2018 - 6
APMA News - July/August 2018 - 7
APMA News - July/August 2018 - Contents
APMA News - July/August 2018 - 9
APMA News - July/August 2018 - 10
APMA News - July/August 2018 - 11
APMA News - July/August 2018 - 12
APMA News - July/August 2018 - 13
APMA News - July/August 2018 - 14
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APMA News - July/August 2018 - 17
APMA News - July/August 2018 - 18
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APMA News - July/August 2018 - 24
APMA News - July/August 2018 - 25
APMA News - July/August 2018 - 26
APMA News - July/August 2018 - 27
APMA News - July/August 2018 - 28
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APMA News - July/August 2018 - Cover3
APMA News - July/August 2018 - Cover4
APMA News - July/August 2018 - APMA1
APMA News - July/August 2018 - APMA2
APMA News - July/August 2018 - APMA3
APMA News - July/August 2018 - APMA4
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