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Quality & Practice

Coding & Reimbursement Resources

Coding incorrectly equals lost revenue. AAPM&R has several resources and educational tools to help physiatrists, billers, coders, and office managers keep up-to-date on the latest PM&R specific coding and billing changes.

The Physiatrist Articles 

AAPM&R has developed a Coding & Reimbursement Tips column in the The Physiatrist to provide you with coding insights. These articles can be used as supportive coding data to appeal insurance denials, validate coding to auditors, train staff and answer day-to-day coding questions. Note: Accurate coding is the responsibility of the provider. These coding article are intended only as a resource to assist in the coding and billing process.

Payer Denials

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 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 codingquestions@aapmr.org or faxed to the attention of Carolyn Winter-Rosenberg or Kate Stinneford at (847) 754-4368. If you would prefer to speak directly to staff regarding your denial issues, please call (847) 737-6000 and ask for Carolyn or Kate.

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.

Coding and Reimbursement Webinars

Throughout the year, AAPM&R sponsors webinars that focus on issues concerning the regulatory, federal, quality, and coding, and reimbursement issues directly related to physiatry.

ICD-10 Resources

To help with the implementation of ICD-10, the AAPM&R offers numerous educational resources and implementation tools to increase your ICD-10 understanding and readiness.

Template Appeals Letter for Physicians Challenging Denials

Template Appeal Letter for Modifier 25