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Urgent® PC Reimbursement
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Macroplastique® Reimbursement
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General Questions Disclaimer: Uroplasty assembled this coding, coverage and payment information as a convenient reference source. It is subject to change without notice as a result of changes in reimbursement laws, regulations and policies. This content is informational only and does not address all possible situations. No guarantee or promise of coverage or payment is represented herein. Providers assume full responsibility for accurate coding and reimbursement decisions and actions. All procedures and services should be accurately documented in the patient’s medical record. Please consult your payer organization if you have questions regarding its specific reimbursement guidelines. Macroplastique® ReimbursementAppeals If your patient’s payer denies coverage for a bulking agent, you and your patient have a right to appeal. Coverage is sometimes denied because the payers do not fully understand the therapy. Consequently, providing information to them can be helpful. Keys to a Successful Appeal The appeal process ensures that critical patient care decisions are given the consideration they deserve. While the information on this website may be helpful to you, Uroplasty, Inc. cannot guarantee your success in gaining coverage. There are several factors that, when used together, give you the best chance to overturn a denial: Step 1: Ask the patient to send a letter to the payer requesting that the coverage decision be reversed. The letter should be written within the deadline mentioned in the denial notice, usually 1 - 4 weeks. It should contain relevant information about the patient, his/her condition, and the therapy. This Sample Patient Letter is available for patients’ use. Step 2: Send a second letter from your office/clinic asking the payer to reconsider the decision to deny coverage. This letter should contain supporting information that may not have been included in the first letter. A copy of this letter should be provided to the patient for his/her record. For faster results, call the payer. This Sample Appeals Letter is available for your use. Appealing a coverage decision can be a lengthy process. Do not get discouraged. There are resources available. You may contact the Uroplasty Reimbursement Solutions Group at 866-258-2182 to guide you in the appeal process.
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