Quality and Practice

Quality & Practice

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 (RPRC) and the Health Policy and Legislation Committee (HP&L) have been working to gather information and vocalize the Academy’s concern to Congress and the Centers for Medicare and Medicaid Services (CMS). Please see our letter regarding Medicare claims denied in IRFs. 

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 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.

The RPRC 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 the meantime, HP&L will continue vocalizing this issue to federal stakeholders. In advance, we truly appreciate your time in helping us address reimbursement and burnout issues across our specialty.