ABPM Exam and the ABMS and Insurance Reimbursement

Hilly · Mar 7, 2009

I am an b/c internist s/p ABA/ACGME pain fellowship. Unfortunately, due to some personal stuff, I did not complete the entire year so I am not eligible for ABPN sub-specialty pain certification that I could have taken if I would have completed the fellowship.
But, I have been accepted to sit for the ABPM boards.
It seems that third party payers won't reimburse for epidurals etc if you don't have ABMS certification???
I know Florida/Calif/Texas, ABPM is considered ABMS equilavent but how about NY/NJ?
Can one legally advertise as a Pain Specialist in other states if certified by the ABPM?
And is there a way to get the insurance companies to reimburse?
Thanks!

Medman2737 · Mar 8, 2009

Hi there,

I am also an Internist and currently applying to pain fellowships. As you know it is not an easy road. Which program did you go through and how was your experience?

About your dilemma, can't you just take the ABPMR sanctioned board exam thus getting you the ABMS certification? Just my 2 cents.

Thanks for any info about fellowships!!

-Dr. P

lobelsteve · Mar 8, 2009

Medman2737 said:
Hi there,

I am also an Internist and currently applying to pain fellowships. As you know it is not an easy road. Which program did you go through and how was your experience?

About your dilemma, can't you just take the ABPMR sanctioned board exam thus getting you the ABMS certification? Just my 2 cents.

Thanks for any info about fellowships!!

-Dr. P

The only ABMS exam for subspecialty certification in Pain Medicine is the same whether from ABA/ABPMR/ABP&N. Same test, different title on the cert.
The AAPMed offers a real exam, but it is not ABMS recognized. The AAPMgmt is a worthless piece of paper.

Tenesma · Mar 9, 2009

Hilly finish your fellowship...

bedrock · Mar 9, 2009

The only ABMS exam for subspecialty certification in Pain Medicine is the same whether from ABA/ABPMR/ABP&N. Same test, different title on the cert.
The AAPMed offers a real exam, but it is not ABMS recognized. The AAPMgmt is a worthless piece of paper.

I thought the ABPM was considered equivalent to the ABMS exam in California, Florida, and Texas?

Disciple · Mar 10, 2009

Hilly said:
It seems that third party payers won't reimburse for epidurals etc if you don't have ABMS certification???

Is that a question?

Hilly · Mar 10, 2009

Disciple said:
Is that a question?

yes it is.

Disciple · Mar 10, 2009

It sounded like a statement that you were uncertain about.

Have you tried submitting billing for any of your injections yet?

Hilly · Mar 11, 2009

yes i have. facets are covered by most. Oxford won't reimburse me. I have no tried for epidurals yet.
any suggestions?

jsaul · Mar 12, 2009

Hilly said:
yes i have. facets are covered by most. Oxford won't reimburse me. I have no tried for epidurals yet.
any suggestions?

i have seen PMR's and anesthesia MDs who never did a pain fellowship get reimbursed for all procedures all the time. And they are only certified through their primary specialty through ABMS. And a couple of the anesthesia docs are not even ABMS certified in anesthesiology yet they have no problem getting reimbursed with pain procedures. then one group tried to bring on an FP who was not fellowship trained and they had problems with reimbursement and subsequently let him go

pmrmd · Mar 12, 2009

jsaul said:
i have seen PMR's and anesthesia MDs who never did a pain fellowship get reimbursed for all procedures all the time. And they are only certified through their primary specialty through ABMS. And a couple of the anesthesia docs are not even ABMS certified in anesthesiology yet they have no problem getting reimbursed with pain procedures. then one group tried to bring on an FP who was not fellowship trained and they had problems with reimbursement and subsequently let him go

the problem is your specialty, which is IM. procedures are appropriate for a specialty. i can't get any kind of reimbursement for a lap chole, no matter what. i would guess a general surgeon would get not get far submitting a 62310 CPT.

Tenesma · Mar 12, 2009

actually a physician can bill any CPT code to medicare that he wishes.... and medicare will typically pay, however if it is a CPT code that your specialty doesn't frequently or rarely/never uses you will be audited within about 6-9 months.

jsaul · Mar 12, 2009

pmrmd said:
the problem is your specialty, which is IM. procedures are appropriate for a specialty. i can't get any kind of reimbursement for a lap chole, no matter what. i would guess a general surgeon would get not get far submitting a 62310 CPT.

that was the point i was making to the original poster.

pmrmd · Mar 13, 2009

Tenesma said:
actually a physician can bill any CPT code to medicare that he wishes.... and medicare will typically pay, however if it is a CPT code that your specialty doesn't frequently or rarely/never uses you will be audited within about 6-9 months.

i don't know about medicare because i won't mess with the feds, but at least once a private insurer did not want to pay because it thought my specialty did not match the service. they were wrong.

Hilly · Mar 17, 2009

pmrmd said:
the problem is your specialty, which is IM. procedures are appropriate for a specialty. i can't get any kind of reimbursement for a lap chole, no matter what. i would guess a general surgeon would get not get far submitting a 62310 CPT.

I spoke with the ABPM. They are going to assist me in getting on the insurance carriers since they are considered an ABMS equilavent. That should hopefully solve this problem.
Any experience with this?

Disciple · Mar 18, 2009

Good luck to you.

I didn't know they provided those types of services.

pmrmd · Mar 18, 2009

Hilly said:
I spoke with the ABPM. They are going to assist me in getting on the insurance carriers since they are considered an ABMS equilavent. That should hopefully solve this problem.
Any experience with this?

interesting. i had no idea they could help. now if only they could open some closed HMO panels that would make my day.

Disciple · Mar 18, 2009

pmrmd said:
now if only they could open some closed HMO panels that would make my day.

You too?

Can state medical associations help with that?

bedrock · Mar 18, 2009

I spoke with the ABPM. They are going to assist me in getting on the insurance carriers since they are considered an ABMS equilavent. That should hopefully solve this problem.

Hilly, What state do you practice in?
As far as I understand the ABPM is only considered to be ABMS equilavent by some states, just wondering out loud if the ABPM can help with this sort of thing in any state or just places like CA, Texas, Florida, etc....

axm397 · Apr 6, 2009

bedrock said:
I thought the ABPM was considered equivalent to the ABMS exam in California, Florida, and Texas?

So I'm studying for the Texas Juris Prudence exam now and it says:

Texas Business & Commerce Code section 17.12; Texas Occupations Code section 101.201; Texas Administrative Code section 164.3

"A physician is authorized to use the term "board Certified" in any advertising for his or her practice only if the specialty board that conferred the certification and the certifying organization is a member board of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists, or of the American Board of Oral and Maxillofacial Surgery"

bedrock · Apr 19, 2009

"A physician is authorized to use the term "board Certified" in any advertising for his or her practice only if the specialty board that conferred the certification and the certifying organization is a member board of the American Board of Medical Specialties or the Bureau of Osteopathic Specialists, or of the American Board of Oral and Maxillofacial Surgery"

axm397,
Thank you for your well-phrased comment.
I have also understood that for advertising purposes you can't say you're board certified in _________specialty unless you are ABMS certified in ______speciality. Advertising aside, focusing on ASC/hospital/insurance credentialing, I've heard that taking the ABPM test and getting their certification is helpful in the previously mentioned states, CA, FL, TX, etc.
However, I'm a fellow and don't have real world experience with this yet and would appreciate comments from those who have had experience getting the ABPM certification and if it influenced their practices or credentialing?

Gern Blansten · Apr 22, 2009

bedrock said:
axm397,
Thank you for your well-phrased comment.
I have also understood that for advertising purposes you can't say you're board certified in _________specialty unless you are ABMS certified in ______speciality. Advertising aside, focusing on ASC/hospital/insurance credentialing, I've heard that taking the ABPM test and getting their certification is helpful in the previously mentioned states, CA, FL, TX, etc.
However, I'm a fellow and don't have real world experience with this yet and would appreciate comments from those who have had experience getting the ABPM certification and if it influenced their practices or credentialing?

In Texas, the wording used to say something like ABMS or their equivalent, of which, the board recognized the ABPM. Since the wording change, this is no longer true. The ABPM was somewhat unfairly lumped in with all of the sham boards.

ABPM Exam and the ABMS and Insurance Reimbursement

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