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Re: Maternal Fetal Medicine Foundation From: James Smeltzer (James.Smeltzer@wellstar.org) Mon Sep 26 12:28:12 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: MFM Foundation - NT Program - overview" Previous message: Philippe Jeanty, MD, PhD: "Re: MFM Foundation - NT Program - overview" Maybe in reply to: Dave Berck: "Maternal Fetal Medicine Foundation" Hi If you have an indication for 76811 that they do not recognize, provide supporting documentation (Medical literature and ACOG opinions and guidelines are best) and appeal. My AR person has not informed me of any problems getting paid for indicated work by Aetna, but i will ask again if you did this with no success... Details are good to provide, especially if this is a matter in which there is a MFM concensus. Do not expect them to pay this code without a specific indication, as this is what used to be a targeted scan. Even though my sonographers complain that we are doing targeted exams on everyone we don't expect to be paid for them unless there is a reason. ;^) The 76805 is the correct code to bill for a complete sonogram for normal indications and dating. Hope this helps. Jim SMeltzer -- James S. Smeltzer, MD, FACOG, SMFM Consultant, Maternal Fetal Medicine Wellstar Physicians' Group Northwest Women's Care 787 Campbell Hill St Marietta GA 30060 James.Smeltzer@wellstar.org VM 678-290-3035 Off 770-528-0260 Page 404-318-3451 >>> orlandoultrasound@hotmail.com 9/23/2005 11:06:54 PM >>> Of those out there whom do insurance billing for fetal ultrasound exams (76811-full detailed fetal studies), what do you think of Aetna's reimbursement guidelines. They have taken statements from the maternal fetal medicine organizations and formed a reimbursement plan to pay for this code with a few distinct ICD codes. If those codes are not met then they will only pay for the limited 76805 exam/code. The lesser code only pays about 53% of the detailed exam. Is anyone in this ultrasiound scanning realm facing this issue, and what are you doing to circumvent this problem. Kevin Kevin Snider RDMS,RDCS,RVT Chad Hall RDMS, RDCS, RVT Orlando Ultrasound Associates, Inc. Diagnostics - Consulting- Education Office: (407)273-7303 Toll Free: (866)-613-7303 Fax (407) 381-2502 From: Dave Berck <djberck@yahoo.com> Reply-To: ultrasound@obgyn.net To: Multiple recipients of list ULTRASOUND <ultrasound@dns.obgyn.net> Subject: Maternal Fetal Medicine Foundation Date: Fri, 23 Sep 2005 21:16:07 -0500 I have just been invited to join the Maternal Fetal Medicine Foundation and to give them money. They seem to be involved with quality assurance for NT measurements / 1st trimester screening. Does anyone have any experience with this organization? Who does my money go to? Why should I give them money to do something the FMF and NTD labs do for free? I'm trying to justify membership in yet another organization. Thanks. -- Dave Berck, MD, MPH David J. Berck, MD, MPH >>>>>>>>>>>>> Confidentiality Disclaimer <<<<<<<<<<<<<<<< This email and any files transmitted with it may contain confidential and /or proprietary information in the possession of WellStar Health System, Inc. ("WellStar") and is intended only for the individual or entity to whom addressed. This email may contain information that is held to be privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any unauthorized access, dissemination, distribution or copying of any information from this email is strictly prohibited, and may subject you to criminal and/or civil liability. If you have received this email in error, please notify the sender by reply email and then delete this email and its attachments from your computer. Thank you. ================================================================ Next message: art fougner, md: "Re: MFM Foundation - NT Program - overview" Previous message: Philippe Jeanty, MD, PhD: "Re: MFM Foundation - NT Program - overview" Maybe in reply to: Dave Berck: "Maternal Fetal Medicine Foundation"

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