I recently dispensed surgical dressings to a Humana patient and all the claims were denied, because they considered part of the global service for the debridement I provided. What recourse do I have? My only thought is in the future to have patients only receive their post operative dressings on a post operative day, rather than on their date of surgical debridement. What do you suggest?
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Short answer lots of luck. Many providers have tried to resolve this w/Humana and other MCR Part C plans to no avail. Your only recourse is to have the patient come back the following day or receive their dressings on a post operative day, when no debridement or even an e/m service is provided. This is one of those I would chalk up to your patient, that their carrier is wrong and despite trying to resolve this, their carrier will simply not budge. You could in the future refer the patient to a large national surgical dressing company for the future. Because they are only billing for the dressings and no other medical services for that patient, that day, they likley will be paid. They also will have a better position to have a higher Return of Investment (ROI) as their purchasing in bulk leads to higher purchasing power.
So before you plunge, be sure of what may be your Return of Investment (ROI) or lack thereof.
That is what did you pay and what will the MCR Part C plan reimburse you for your trouble.
In plain English, it may simply not be worth it!!!