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Noridian MBB audit

Discussion in 'Pain Medicine' started by onewithpain, 04.06.12.

  1. onewithpain

    onewithpain

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    I found a printout from my front office on my desk this a.m. with a summary of findings of the Noridian claim review for MBBs. By state, with allowed/denied; NDak=30/69, SDak=29/193, Wyo=11/161, Mont=0/100, Ut=0/142, Az=0/913, Ak=0/108, Or=16/688, Wa=7/880. It has an education page that is a bit ambiguous and it says that if that page is not enough then you can arrange for a one-on-one. I'm going to need it.
  2. 101N

    101N

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    So am I. This is simply a denial of service.
  3. onewithpain

    onewithpain

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    I just cancelled my medicare MBB/RFAs for today, and my MA says I have a ton for next week that we'll cancel. I am calling the patients and explaining this to them and asking them to call and complain. They are very understanding and sound willing. I do a lot of procedures at a small critical access hopsital and I showed this to the CEO who said that this looks like a class-action lawsuit. Noridian needs to hear as many voices as we can muster.
  4. Gauss

    Gauss Damnit Jim!

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    I used to have Mbbs every other day. I haven't had one approved in 3 months. I have to prior auth nearly all of them because my major payor is HMO and managed Mcare.
  5. PinchandBurn

    PinchandBurn

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    I dont get it. I thought if a patient had Medicare, you didnt need a PA? You just did hte procedure......for RFA different story.
  6. Gauss

    Gauss Damnit Jim!

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    Managed Mcare = HMO. Straight Mcare is another story. A lot of hmos are scaring Mcare pts into signing up with them to get drug coverage benefits
  7. onewithpain

    onewithpain

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    That's scary for me. We have no HMOs here, but lots of MC. Pacificsource is the private insurance of the year and they are a pain, but once you jump through their hoops and waste a bunch of their and the patient's money then they will let you do MBB/RFA. Noridian said that they would do this audit, but they never specified the requirements before and they still say no PA required. Instead of prior auth it is now post auth.
  8. knoxdoc

    knoxdoc New Member

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  9. knoxdoc

    knoxdoc New Member

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    Do you have a number for Noridian that I can give to patients? Every time I have explained it, the patient gets pissed at me - like its my fault Noridian blows.

    I'd love to see that printout too. My partners need some educating.
  10. stim4u

    stim4u Member

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    you best get your state pain societies involved, and take some political action, or lawsuits. Otherwise your laziness will effect the rest of us....
  11. onewithpain

    onewithpain

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    https://www.noridianmedicare.com/partb/coverage/lumbar_facet_blockade/findings.html is the review. In it you can click on a link to the LCD for facet injections. My patients have said that their statements from medicare have phone #s. I haven't looked for one myself but the review page has an email address to contact them.

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