Payer Denials: A Note from Annie Purcell, DO, FAAPMR

Members & Publications


April 30, 2018

In recent months, there has been an increase in volume of payer denial-related discussions on PhyzForum. Members of the Reimbursement and Policy Review Committee recently discussed these denials at our in-person meeting in the context of our ongoing payer and reimbursement advocacy work. We acknowledged that our grasp of the severity of denial issues is limited to the information our members provide to us. We would like to identify denial patterns, which the Academy may be able to address through advocacy efforts.

We want to know more so that we can determine how to better support AAPM&R members. If you have experienced a denial within the past year for what you believe is or should have been considered a medically-necessary service, we would like to hear about it. Please respond to the below request by May 21, 2018.

Please share with us a copy of the denial notification you received indicating the service billed and the reason for denial. The notification may come in the form of a denial letter, a claim adjudication notice, a remittance advice, or any other form. If you are not sure whether what you have is a denial, please feel free to contact AAPM&R staff identified below. In order to be HIPAA compliant, please remove (black out) all patient-related information. Information shared will be collected by Academy staff to create a database of denial issues experienced by our members. Information can be emailed to or faxed to the attention of Carolyn Winter-Rosenberg or Kate Stinneford at (847) 754-4368 now through May 21, 2018. If you would prefer to speak directly to staff regarding your denial issues, please call (847) 737-6000 and ask for Carolyn or Kate.

Beginning in May, the Reimbursement and Policy Review Committee will review the data gathered to identify denial patterns. This data will inform priorities and the development of resources to support our members in optimizing reimbursement. In advance, we truly appreciate your time in helping us address reimbursement issues across our specialty.

Annie Purcell, DO, FAAPMR

Chair, Reimbursement and Policy Review Committee


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.