<html> <head> <title>OCM Portal</title> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <script language="JavaScript"> <!-- function MM_swapImgRestore() { //v3.0 var i,x,a=document.MM_sr; for(i=0;a&&i<a.length&&(x=a[i])&&x.oSrc;i++) x.src=x.oSrc; } function MM_preloadImages() { //v3.0 var d=document; if(d.images){ if(!d.MM_p) d.MM_p=new Array(); var i,j=d.MM_p.length,a=MM_preloadImages.arguments; for(i=0; i<a.length; i++) if (a[i].indexOf("#")!=0){ d.MM_p[j]=new Image; d.MM_p[j++].src=a[i];}} } function MM_swapImage() { //v3.0 var i,j=0,x,a=MM_swapImage.arguments; document.MM_sr=new Array; for(i=0;i<(a.length-2);i+=3) if ((x=MM_findObj(a[i]))!=null){document.MM_sr[j++]=x; if(!x.oSrc) x.oSrc=x.src; x.src=a[i+2];} } //--> </script> <link rel="stylesheet" href="styles/OCMstyles.css" type="text/css"> <script language="JavaScript"> <!-- <!-- today = new Date(); var isnMonths = new isnArray("January","February","March","April","May","June","July","August","September","October","November","December"); var isnDays = new isndayArray("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); function isnArray() { argnr = isnArray.arguments.length for (var i = 0;i<argnr;i++) { this[i+1] = isnArray.arguments[i]; } } function isndayArray() { argnr = isndayArray.arguments.length for (var i = 0;i<argnr;i++) { this[i+1] = isndayArray.arguments[i]; } } function getFullYear(d) { var y = d.getYear(); if (y < 1000) y += 1900; return y; } function getDay(d) { var dow = d.getDay(); return dow; } var displayDateTime = isnDays[getDay(today)+1]+", " +isnMonths[today.getMonth()+1]+" "+today.getDate()+", "+" "+getFullYear(today); var displayDateYear = getFullYear(today); // --> function MM_findObj(n, d) { //v4.01 var p,i,x; if(!d) d=document; if((p=n.indexOf("?"))>0&&parent.frames.length) { d=parent.frames[n.substring(p+1)].document; n=n.substring(0,p);} if(!(x=d[n])&&d.all) x=d.all[n]; for (i=0;!x&&i<d.forms.length;i++) x=d.forms[i][n]; for(i=0;!x&&d.layers&&i<d.layers.length;i++) x=MM_findObj(n,d.layers[i].document); if(!x && d.getElementById) x=d.getElementById(n); return x; } //--> </script> </head> <body bgcolor="#FFFFFF" text="#000000" leftmargin="0" topmargin="0" marginheight="0" marginwidth="0" onload="MM_preloadImages('images/NavBut_homeROLL.gif','images/NavBut_DisOCMRoll.gif','images/NavBut_NatPresROLL.gif','images/NavBut_careersROLL.gif','images/NavBut_InvestRelROLL.gif','images/NavBut_helpROLL.gif','images/navbut_servavail_on.gif','images/navbut_service_on.gif','images/navbut_clinic_on.gif','IMAGES/navbut_salesteam_on.gif')"> <table width="100%" height="100%" border="0" cellpadding="0" cellspacing="0"> <tr> <td width="170" height="86" valign="top"> <a href="index.html"> <img src="images/OneCallMedical_logo.gif" width="170" height="86" border="0"></a></td> <td colspan="2" valign="bottom" align="left"> <img src="images/OCM_tagline.gif" width="240" height="41"></td> <td width="265" valign="bottom" align="right" class="date"> <p class="date"> <script language="javascript">document.write(displayDateTime);</script> </p> </td> <td width="100%" valign="top"> <img src="images/spacer.gif" width="1" height="1"></td> <td width="1"> </td> </tr> <tr> <td height="45" valign="top" align="left"> <img src="images/topbanner_1.gif" width="170" height="45"></td> <td valign="top" align="left" colspan="2"> <img src="images/topbanner_2.gif" width="240" height="45"></td> <td valign="top" align="left"> <img src="images/topbanner_3.gif" width="265" height="45"></td> <td valign="top" bgcolor="#3450AF" align="left"> <img src="images/spacer.gif" width="1" height="1"></td> <td> </td> </tr> <tr> <map name="LoginHere"> <area shape="rect" coords="7,16,155,38" href="https://claimstatus.onecallmedical.com:443/ocmportal/OCMPortal?PID=Login"> </map> <td height="120" valign="top"> <img src="images/LoginArea.gif" width="170" height="120" usemap="#LoginHere" border="0"></td> <td width="16" rowspan="4" valign="top"> &nbsp;</td> <td valign="middle" colspan="2" align="left"> <img src="images/hdrClinicalServicesFAQs.gif" width="266" height="42"></td> <td> </td> <td> </td> </tr> <tr> <td valign="top" height="178" align="left" bgcolor="#FFFFFF"> <table width="170" border="0" cellspacing="0" cellpadding="0"> <tr> <td height="25" width="170" valign="top"> <a href="index.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('Home','','images/NavBut_homeROLL.gif',1)"> <img name="Home" border="0" src="images/NavBut_home.gif" width="170" height="25"></a></td> </tr> <tr> <td height="24" valign="top"> <a href="discoverOCM.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('Discover OCM','','images/NavBut_DisOCMRoll.gif',1)"> <img name="Discover OCM" border="0" src="images/NavBut_DisOCM.gif" width="170" height="36"></a></td> </tr> <tr> <td height="24" valign="top"> <a href="NationalPresence.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('serviceavailability','','images/navbut_servavail_on.gif',1)"> <img name="serviceavailability" border="0" src="images/navbut_servavail_off.gif" width="170" height="24"></a></td> </tr> <tr> <td height="23" valign="top"> <a href="OCM_team.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('SalesTeam','','IMAGES/navbut_salesteam_on.gif',1)"> <img src="IMAGES/navbut_salesteam_off.gif" alt="Our Sales Team" name="SalesTeam" width="170" height="24" border="0"></a></td> </tr> <tr> <td height="23" valign="top"> <a href="Providers.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('Providers','','IMAGES/navbut_providers_on.gif',1)"> <img src="IMAGES/navbut_providers_off.gif" alt="Providers" name="Providers" width="170" height="24" border="0"></a></td> </tr> <tr> <td height="23" valign="top"> <a href="http://tbe.taleo.net/NA7/ats/careers/jobSearch.jsp?org=OCM&cws=1" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('Careers','','images/NavBut_careersROLL.gif',1)"> <img name="Careers" border="0" src="images/NavBut_careers.gif" width="170" height="23"></a></td> </tr> <tr> <td height="22" valign="top"> <a href="services.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('services','','images/navbut_service_on.gif',1)"> <img name="services" border="0" src="images/navbut_service_off.gif" width="170" height="24"></a></td> </tr> <tr> <td height="22" valign="top"> <a href="InvestorRelations.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('Investor Relations','','images/NavBut_InvestRelROLL.gif',1)"> <img name="Investor Relations" border="0" src="images/NavBut_InvestRel.gif" width="170" height="24"></a></td> </tr> <tr> <td height="19" valign="top"> <a href="clinicaled.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('Clinical Education','','images/navbut_clinic_on.gif',1)"> <img name="Clinical Education" border="0" src="images/navbut_clinic_off.gif" width="170" height="24" alt="Clinical Education"></a></td> </tr> <tr> <td height="19" valign="top"> <a href="Help_Contactus.html" onmouseout="MM_swapImgRestore()" onmouseover="MM_swapImage('Contact Us','','images/NavBut_helpROLL.gif',1)"> <img name="Contact Us" border="0" src="images/NavBut_help.gif" width="170" height="25"></a></td> </tr> <tr> <td height="18" valign="top"> <img src="images/NavBut_bottom.gif" width="170" height="21"></td> </tr> <tr> <td height="266" valign="top"> <table width="100%" border="0" cellpadding="0" cellspacing="0"> <tr> <td width="23" height="246"> </td> <td width="147" valign="top" height="350"> <BR> <p class="NavText"> <a href="TermsOfUse.html">Terms of Service</a></p> <p class="NavText"> <a href="PrivacyPolicy.html">Privacy Statement</a></p> </td> </tr> </table> </td> <!--2 tds--> <td> </td> </tr> </table> </td> <td valign="top" colspan="2" rowspan="3"> <table width="100%" border="0" cellpadding="0" cellspacing="0"> <tr> <td width="489" height="425" valign="top" class="bodyText"> <p class="storytitle"> <a href="ClinicalServicesFAQs.html?#neurodiagnostic">NEURODIAGNOSTIC PROVIDERS CLICK HERE</a></p> <p class="storytitle"> RADIOLOGY PROVIDERS</p> <p class="subheadtext"> Who can approve a CPT Code change (or addition) from those on an authorization?</p> <p> <span style='font-size: 9.0pt; font-family: Verdana'>Clinical Services approves changes to CPT codes. Per policy, research is done including the referring physician&#39;s request and the adjuster&#39;s authorization (see <a href="PDFs/policy-3.01.04-coding-worksheets-for-procedures.pdf" target="_blank">CLS Policy 3.01.04</a>). Contact Clinical Services at 800-872-2875, extension 3431 or <a href="mailto:clinical@onecallmedical.com">email</a> your request and include the patient name, Date of Service, provider contact and requested change with reason for change. You may also fax your request to Clinical Services at 973-257-1363.</span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Patient is at your facility, how can I have the CPT code changed immediately?<o:p></o:p></span></b></p> <p> <span style='font-size: 9.0pt; font-family: Verdana'><a href="mailto:clinical@onecallmedical.com"> Email</a> is the fastest method to have a CPT code approved.<span style='mso-spacerun: yes'> </span>If you do not have access to e-mail, please call OCM&#39;s <st1:place w:st="on"><st1:PlaceName w:st="on">Customer</st1:PlaceName> <st1:PlaceName w:st="on">Contact</st1:PlaceName> <st1:PlaceType w:st="on">Center</st1:PlaceType></st1:place> and the next available agent will e-mail your request to <st1:personname w:st="on">Clinical Services</st1:personname> for prompt review. Please place the provider&#39;s state in the subject line of your e-mail for prompt response by the assigned nurse.<o:p></o:p></span></p> <p class="MsoNormal"> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Can a provider have copies of the OCM approved CPT coding worksheets?<o:p></o:p></span></b></p> <p class="MsoNormal"> <span style='font-size: 9.0pt; font-family: Verdana'>Click here to review the OCM CPT Coding worksheets:</p> <ul> <li><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/Coding-Worksheet-MRI-Arthrograms-Providers.pdf" target="_blank">MRI Arthrograms</a></span></li> <li><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/Coding-Worksheet-CT-Arthrograms-Providers.pdf" target="_blank">CT Arthrograms</a></span></li> <li><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/Coding-Worksheet-Arthrograms-Providers.pdf" target="_blank">Arthrograms</a></span></li> <li><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/Coding-Worksheet-Myelogram-Providers.pdf" target="_blank">Myelograms</a></span></li> <li><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/Coding-Worksheet-Bone-Scans-Providers.pdf" target="_blank">Bone Scans</a></span></li> <li><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/Coding-Worksheet-Infrequent-MRIs-Providers.pdf" target="_blank">Infrequent MRI</a></span></li> <li><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/Coding-Worksheet-2D-3D-Reconstruction-or-Rendering.pdf" target="_blank">2-D and/or 3-D Reconstruction or Rendering</a></span></li> </ul> <p> Please note that the CPT codes are based upon the current year and not the individual state&#39;s workers&#39; compensation CPT codes.<span style='mso-spacerun: yes'> </span> Download the <a href="PDFs/policy-3.01.03.02-CPT-Code-Update-By-State.pdf" target="_blank"> CPT coding by year by state</a> CLS Policy 3.01.03.02.<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>If the patient has had prior surgery and the authorization is for MRI, can the radiologist determine that contrast needs to be given?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Yes.<span style='mso-spacerun: yes'> </span>Per policy, the radiologist can determine contrast when it is NOT specified on the authorization by documentation in the medical report.<span style='mso-spacerun: yes'> </span>(See Requirements & Exceptions for Radiology Order Revisions <a href="PDFs/policy-3.03.06-requirements-exceptions-radiology-orders.pdf" target="_blank">CLS Policy 3.03.06</a>, and Ordering Radiology Diagnostic Tests <a href="PDFs/policy-3.03.05-ordering-diagnostic-radiology-tests.pdf" target="_blank">CLS Policy 3.03.05</a>)<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Can a provider appeal a denied CPT code on radiology claim?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Yes. Providers may appeal denied CPT code(s) by completing the Medical Claim Appeals for Radiology form and submitted the appeal to Clinical Services. (<a href="PDFs/policy-9.08-provider-radiology-med-claim-appeal.pdf" target="_blank">Provider Radiology Medical Claim Appeal Policy</a> CLS Policy 9.08, <a href="PDFs/form-provider-med-claim-appeal-radiology.pdf" target="_blank">Provider Radiology Medical Claim Appeal Form</a> CLS Policy 9.09)<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Who reviews medical claim appeals?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <st1:personname w:st="on"><span style='font-size:9.0pt;font-family:Verdana'>Clinical Services</span></st1:personname> <span style='font-size: 9.0pt; font-family: Verdana'>staff reviews the medical claim appeals.<span style='mso-spacerun: yes'> </span>If an appeal is approved, the Manager of <st1:personname w:st="on">Clinical Services</st1:personname> approves the appeal.<span style='mso-spacerun: yes'> </span>If <st1:personname w:st="on">Clinical Services</st1:personname> recommends denial or partial denial, then a medical consultant, a board certified radiologist must determine the outcome of the appeal. <o:p></o:p> </span> </p> <p class="MsoNormal"> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>How will a provider be notified of the results of an appeal?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>All appeals are completed on the appeal form, Provider Radiology Medical Claim Appeal form (<a href="PDFs/form-provider-med-claim-appeal-radiology.pdf" target="_blank">CLS 9.09</a>), and a letter is sent to the provider.<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Can a provider appeal a denied appeal?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Yes.<span style='mso-spacerun: yes'> </span>A provider who submits medical justification or additional information can complete a second level appeal.<span style='mso-spacerun: yes'> </span>A member of OCM s medical advisory board reviews all second level appeals.<span style='mso-spacerun: yes'> </span>RAB Fact Sheet (<a href="PDFs/fact-sheet-1.03.03-radiology-advisory-board.pdf" target="_blank">CLS 1.03.03</a>).<span style='mso-spacerun: yes'> </span>A second level appeal completes the appeal process.<o:p></o:p></span></p> <a name="neurodiagnostic"></a> <p class="MsoNormal" align="center" style='text-align: center'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 16.0pt'> <o:p>&nbsp;</o:p> </span></b> </p> <p class="storytitle"> NEURODIAGNOSTIC PROVIDERS</p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>What are the requirements for sample EMG &amp; NCS reports for credentialing?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; tab-stops: list .5in'> <span style='font-size: 9.0pt; font-family: Verdana'>Three (3) studies are required, including <b>ABNORMAL</b> diagnoses of CTS, Radiculopathy and a Lower Limb study.<span style='mso-spacerun: yes'> </span>Samples must include both needle EMG and nerve conduction studies.<span style='mso-spacerun: yes'> </span>Numerical data for NCS, including amplitudes, latencies and/or conduction velocities are required.<span style='mso-spacerun: yes'> </span>A list of muscles studied is required and the studies cannot be limited studies (less than 5 muscles per limb). (<a href="PDFs/guidelines-guide-sample-medical-reports.pdf" target="_blank">Guide for Sample Medical Reports - CLS policy 11.03.03</a>).<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; tab-stops: list .5in'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>What is the source for Standards for One Call Medical EMG &amp; NCS Reports?<o:p></o:p></span></b></p> <p class="MsoNormal" style='tab-stops: list .5in'> <span style='font-size: 9.0pt; font-family: Verdana'>Sources include:<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l2 level1 lfo1; tab-stops: list .5in 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'><a href="PDFs/guidelines-AANEM-recommended-policy.pdf" target="_blank">American Association of Neuromuscular &amp; Electrodiagnostic (AANEM) Recommended Guidelines</a>;<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l2 level1 lfo1; tab-stops: list .5in 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>AMA CPT Assistant, Vol. 12, April, 2002 and Vol. 14, July, 2004;<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l2 level1 lfo1; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Jablecki CK, Busis NA, Brandstater MA, Krivickas LS, Miller RG, Robinton JE. Reporting the Results of Needle<span style='mso-spacerun: yes'> </span>EMG and Nerve Conduction Studies: an Educational Report. Prepared by American Association of Neuromuscular<span style='mso-spacerun: yes'> </span>&amp; Electrodiagnostic Medicine for Muscle Nerve 2005;32:682-685;<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l2 level1 lfo1; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>AANEM Practice Parameters.<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Who can provide additional information on sample medical reports?<o:p></o:p></span></b></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l0 level1 lfo2; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><st1:personname w:st="on"><span style='font-size:9.0pt;font-family:Verdana'>Clinical Services</span></st1:personname><span style='font-size: 9.0pt; font-family: Verdana'> will be happy to provide additional information on sample medical reports.<span style='mso-spacerun: yes'> </span>You can <a href="mailto:clinical@onecallmedical.com">email</a> <span style='color: red'> E4</span> or call the <st1:personname w:st="on">Clinical Services</st1:personname> Message Center (CSMC) at 800-872-2875, extension 3431.<span style='mso-spacerun: yes'> </span>You may also send a request via fax at 973-257-1363.<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>How can I contact the Medical Director?<o:p></o:p></span></b></p> <p class="MsoNormal"> <span style='font-size: 9.0pt; font-family: Verdana'>Choose the method of contact that is most convenient for you:<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l0 level1 lfo2; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>e-mail: <a href="mailto:john_robinton@onecallmedical.com">john_robinton@onecallmedical.com</a><o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l0 level1 lfo2; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>phone:<span style='mso-spacerun: yes'> </span>800-872-2875, extension 3623<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l0 level1 lfo2; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>fax:<span style='mso-spacerun: yes'> </span>973-257-1363<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l0 level1 lfo2; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>mail:&nbsp;&nbsp;&nbsp;&nbsp;John E. Robinton, M.D.<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 1.5in'> <span style='font-size: 9.0pt; font-family: Verdana'>Clincal Services<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 1.5in'> <span style='font-size: 9.0pt; font-family: Verdana'>One Call Medical, Inc.<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 1.5in'> <st1:street w:st="on"><st1:address w:st="on"><span style='font-size:9.0pt;font-family:Verdana'>20 Waterview Blvd.</span></st1:address></st1:street> <span style='font-size: 9.0pt; font-family: Verdana'> <o:p></o:p> </span> </p> <p class="MsoNormal" style='margin-left: 1.5in'> <st1:place w:st="on"><st1:City w:st="on"><span style='font-size:9.0pt;font-family:Verdana'>Parsippany</span></st1:City><span style='font-size:9.0pt;font-family:Verdana'>, <st1:State w:st="on">NJ</st1:State><span style='mso-spacerun:yes'>  </span><st1:PostalCode w:st="on">07054-0614</st1:PostalCode></span></st1:place> <span style='font-size: 9.0pt; font-family: Verdana'> <o:p></o:p> </span> </p> <p class="MsoNormal"> <o:p>&nbsp;</o:p> </p> <p class="MsoNormal"> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Can a provider receive reimbursement for EMG &amp; NCS testing of an unauthorized limb?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Providers should follow the Unauthorized Asymptomatic Contralateral Limb policy.<span style='mso-spacerun: yes'> </span>(<a href="PDFs/policy-3.02.11-unauthorized-asymptomatic-contralateral-limb-testing.pdf" target="_blank">CLS Policy 3.02.11</a>)</span>.<o:p></o:p></u></i></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>How can a provider increase referrals?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Referral volume is dependent upon many factors.<span style='mso-spacerun: yes'> </span>Provider can control one factor by adherence to the Standards for EMG Reports.<span style='mso-spacerun: yes'> </span> For more information, <a href="mailto:clinical@onecallmedical.com">email</a> <span style='color: red'>E4</span> or call the <st1:personname w:st="on">Clinical Services</st1:personname> Message Center (CSMC) at 800-872-2875, extension 3431.</span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>What are the guidelines for reimbursement of Nerve Conduction Studies?<span style='mso-spacerun: yes'> </span> <o:p></o:p> </span></b> </p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Reimbursement is based upon the AANEM Recommended Policy for Electrodiagnostic Medicine and OCM Policies &amp; Procedures.<span style='mso-spacerun: yes'> </span>(see <a href="PDFs/policy-3.14.01-NCS-reimbursement.pdf" target="_blank">NCS Reimbursement Policy 3.14.01</a>).</p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>What are the guidelines for reimbursement of needle EMG?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Reimbursement is based upon the AANEM Recommended Policy for Electrodiagnostic Medicine, Federal Register, Vol. 62, No. 211, and OCM Policies &amp; Procedures.<span style='mso-spacerun: yes'> </span> (see <a href="PDFs/policy-3.13.01-Needle-EMG-Reimbursement.pdf" target="_blank">Needle EMG Reimbursement Policy 3.13.01</a>).</span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>How many muscles are required for a needle EMG of an extremity for CPT code 95860?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>More than five muscles are required. See Federal Register 62-211 (<a href="PDFs/policy-3.13.02-Federal-Register-62-211.pdf" target="_blank">Policy 3.13.02</a>).</span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Why does <st1:personname w:st="on">Clinical Services</st1:personname> send faxes for Incomplete Bills?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <st1:personname w:st="on"><span style='font-size:9.0pt;font-family:Verdana'>Clinical Services</span></st1:personname> <span style='font-size: 9.0pt; font-family: Verdana'> staff reviews EVERY EMG & NCS medical report upon receipt of a bill and determines if the report received is incomplete.<span style='mso-spacerun: yes'> </span>Examples of missing information include:<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>list of muscles tested<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>numerical data for Nerve Conduction Studies (NCS)<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Amplitudes when only latencies have been submitted for NCS<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Consultation/office notes when Evaluation &amp; Management CPT codes are billed<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Narrative report does not match numerical data/EMG muscles<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Report does not match authorized procedure<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Report does not match billed CPT codes<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Why does <st1:personname w:st="on">Clinical Services</st1:personname> send faxes entitled Bill Query?<o:p></o:p></span></b></p> <p class="MsoNormal"> <span style='font-size: 9.0pt; font-family: Verdana'>Bill Query faxes are a service provided to reimburse OCM providers correctly the first time.<span style='mso-spacerun: yes'> </span>This also decreases the number of appeals to be processed by both providers and by <st1:personname w:st="on">Clinical Services</st1:personname> .<span style='mso-spacerun: yes'> </span> <st1:personname w:st="on">Clinical Services</st1:personname>  staff reviews EVERY medical report upon receipt of a bill and determines if the bill received is incomplete.<span style='mso-spacerun: yes'> </span>Examples of missing CPT codes include:<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>No EMG billed but list of muscles documented<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Nerve Conduction Studies (NCS) documented but not billed<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Documentation of many NCS but only one unit billed for motor and/or one unit billed for sensory<o:p></o:p></span></p> <p class="MsoNormal" style='margin-left: 75.0pt; text-indent: -.25in; mso-list: l1 level1 lfo3; tab-stops: list 75.0pt'> <![if !supportLists]><span style='font-size: 9.0pt; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings'><span style='mso-list: Ignore'>Ø<span style='font: 7.0pt "Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><![endif]><span style='font-size: 9.0pt; font-family: Verdana'>Narrative report does not match billed CPT codes<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>When does a provider need to respond to a Bill Query?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>If a provider disagrees with a faxed Bill Query, then a response is required within five business days.<span style='mso-spacerun: yes'> </span> <o:p></o:p> </span> </p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Can a provider appeal a denied CPT code?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Yes. Providers may appeal denied CPT code(s) by completing the Neurodiagnostic Medical Claim Appeal form and submitted the appeal to Clinical Services. (<a href="PDFs/policy-9.01-provider-neurodx-med-claim-appeal.pdf" target="_blank">Provider Neurodx Medical Claim Appeal - CLS Policy 9.01</a>, and see <a href="PDFs/form-provider-med-claim-appeal-neurodiagnostics.pdf" target="_blank">Provider Neurodx Med Claim Appeal Form 9.02</a>)</span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Who reviews medical claim appeals?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <st1:personname w:st="on"><span style='font-size:9.0pt;font-family:Verdana'>Clinical Services&#39;</span></st1:personname> <span style='font-size: 9.0pt; font-family: Verdana'>staff review the medical claim appeals.<span style='mso-spacerun: yes'> </span>If an appeal is approved, the Manager of <st1:personname w:st="on">Clinical Services</st1:personname> approves the appeal.<span style='mso-spacerun: yes'> </span>If an appeal is denied or partially denied by <st1:personname w:st="on">Clinical Services</st1:personname> &#39; staff, then a medical consultant, board certified, practicing physician electromyographer completes the appeals.<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>How will a provider be notified of the results of an appeal?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>All appeals are completed on the appeal form (see <a href="PDFs/form-provider-med-claim-appeal-neurodiagnostics.pdf" target="_blank"> Provider Neurodx Med Claim Appeal form - CLS 9.02</a>) which is sent to the provider.<o:p></o:p></span></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <b style='mso-bidi-font-weight: normal'><span style='font-size: 10.0pt; font-family: Verdana; color: navy'>Can a provider appeal a denied appeal?<o:p></o:p></span></b></p> <p class="MsoNormal" style='mso-margin-top-alt: auto; mso-margin-bottom-alt: auto'> <span style='font-size: 9.0pt; font-family: Verdana'>Yes.</span><span style='font-size: 9.0pt; font-family: Verdana'><span style='mso-spacerun: yes'> </span>A provider who submits medical justification or additional information can complete a second level appeal.<span style='mso-spacerun: yes'> </span>A member of OCM&#39;s medical advisory board reviews all second level appeals. NMAB Fact Sheet(<a href="PDFs/fact-sheet-1.03.02.neurodx-med-advisory-board.pdf" target="_blank">CLS 1.03.02</a>) <span style='color: red'>D28</span>. A second level appeal completes the appeal process</span>.</p> </td> </tr> </table> </td> <td rowspan="2"> </td> <td> </td> </tr> <tr> <td height="30"> </td> <td> </td> <td> </td> </tr> <tr align="center" valign="bottom"> <td height="74" colspan="6"> </td> </tr> <tr> <td height="1"> <img height="1" width="170" src="images/spacer.gif"></td> <td> <img height="1" width="16" src="images/spacer.gif"></td> <td> <img height="1" width="224" src="images/spacer.gif"></td> <td> <img height="1" width="265" src="images/spacer.gif"></td> <td> </td> <td> <img height="1" width="1" src="images/spacer.gif"></td> </tr> <tr height="30"> <td colspan="6"> <img src="images/spacer.gif" width="1" height="30" /></td> </tr> <tr> <td height="1"> <img height="1" width="170" src="images/spacer.gif"></td> <td colspan="5"> <font class="legalText">Contact our <a href="&#109;&#97;&#105;&#108;&#116;&#111;&#58;&#119;&#101;&#98;&#109;&#97;&#115;&#116;&#101;&#114;&#64;&#111;&#110;&#101;&#99;&#97;&#108;&#108;&#109;&#101;&#100;&#105;&#99;&#97;&#108;&#46;&#99;&#111;&#109;"> Webmaster</a> for website questions, suggestions, or to report a problem with our site.<br> The on-line services provided by One Call Medical, Inc. are for the exclusive use of One Call Medical customers.<br> &copy; 2002-<script language="javascript">document.write(displayDateYear)</script> One Call Medical, Inc. All rights reserved. Unauthorized access is strictly prohibited. Usage will be monitored.</font> </td> </tr> </table> </body> </html>