Check the dates of service on the Payment Summary Form. In some cases, Medicare may have included charges that were incurred before or after your client's treatment for the injuries relevant to your case.
Ensure all of the services provided are related.
Make sure that the services being reimbursed are actually related to the injuries sustained by your client. But how do you know whether diagnosis code "25000" is related to your case? The diagnosis codes on the Payment Summary Form can easily be interpreted by looking up the code in the ICD-9-CM Tabular List of Diseases.
Where to find an ICD-9-CM Tabular List of Diseases
There are many ways to access the ICD-9-CM Tabular List of Diseases. You can download the list from http://www.cdc.gov/nchs/icd9.htm. In addition, there are various websites that allow you to search for the translation of a code. One user friendly website is http://icd9cm.chrisendres.com/.
Translating the Diagnosis Codes
It is fairly simple to find your code in the Tabular List of Diseases. The diagnosis codes range from three to five digits long and begin with a number or the letters V or E. When searching for a code that begins with a number or the letter E, you will need to insert a decimal point between the third and fourth number in the code. When searching for a code that begins with the letter V, you will need to insert a decimal point between the second and third numbers in the code. For example, in order to look up diagnosis code "25000" you must actually find "250.00" in the Tabular List. Once you determine that diagnosis code "25000" is billed for treatment of diabetes, you will be able to cross that charge off the Medicare lien in your case arising out of a head injury your client sustained in an auto accident.
Dispute the unrelated dates and services.
Now that you have found all of the charges that you intend to dispute, what do you do? Simply draw a line through all unrelated services on the payment summary form and send that form with a letter explaining your dispute to Medicare. The previous contractor for Medicare (United Government Services) was replaced by the Chickasaw Nation Industry, which is calling itself the Medicare Secondary Payer Recovery Contractor, and can be contacted at:
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