Mathew Levy, Esq. and his associate Stephen Cucolo, Esq. recently defended an ABA provider and this ABA provider is now reinstated with full billing authorization related to Optum investigation and suspension.
Optum placed a billing flag on the ABA practice, without providing clear information for why the billing flag was implemented and refused to give a detailed explanation for the decision. Our team worked with the practice to review the practice’s documentation and coding to confirm that the practice was meeting all relevant CPT guidelines and Optum policy requirements. Once we were able to rule out billing anomalies we had to determine other potential reasons for the flag. Ultimately, by leveraging our experience in health care audits and investigations we were able to determine that the cause of the billing flag was an administrative error by a third party. The team was able to explain the issue to the plan which ultimately resulted in the practice being reinstated and reimbursed for claims that were improperly denied during the billing hold.
