For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review and including IBR decisions as supporting documentation.
Official Medical Fee Schedule
Physician Services
CPT Code(s)
Physical Medicine / Chiropractic / Acupuncture Multiple Procedure Payment Reduction; Pre-Authorization for Specified Procedure / Modality Services
Payable
Yes
EOR Denial Reason
Maximum units exceeded.
Second Review Reason (SBR-1)
Recommended Reason
MUE incorrectly cited as reason for $0 reimbursement. § 9789.12.13 Correct Coding Initiative.
(c) Medically Unlikely Edits are published by CMS on its website at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html document “Practitioner Services MUE Table.” See section 9789.19 for the adopted version of the Practitioner Services MUE Table, by date of service.
DaisyBill Resources
Webinar: Request for Second Review
Webinar: Second Review Strategy Kit, Part I
Webinar: Second Review Strategy Kit, Part II
DaisyBill Solution
Every request for Second Review submitted from DaisyBill is compliantly submitted using both a completed DWC Form SBR-1, as well as a compliant modified CMS 1500.
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