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As we all know, benefit payments are reliant on a number of issues including correct billing, proof of medical necessity, the qualifications of the consultant or claims examiner. The outcome measurement report is a valuable outcome measurement document to demonstrate medical necessity. X Ray reports and other supporting documentations should also be attached.
Some carriers pay and some do not. What I have outlines above is an example of scenario's which could be played out. Key elements are proper alignment of diagnosis (ICDA-9) to procedures (CPT). Patients with serious orthopedic issues need your attention and intervention. I recommend you fight claims which are arbitrarily denied. Many times the consultant reviewing the claim is not qualified, (example RN or LVN).
Especially in patients who have had complications from injury or surgery (example joint implant surgery), may need to have a letter explaining the value that static and dynamic 3D kinematic imaging and analysis provides in preventing more costly surgery. Many surgical procedures fail because the pathomechanical etiology is not or has not been addressed.
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