04/25/2024

Your Assistance Needed for Two Potential Lawsuits

APMA is requesting your assistance regarding two proposed lawsuits:

1. The first is a potential class action lawsuit regarding Modifiers 25 and 59. Health plans may be inappropriately denying and/or underpaying podiatric practices when appropriately documented separate, distinct services are provided at the same encounter. For example, it appears that some claims containing Modifier 25 have been bundled by certain health plans’ electronic claims processing software, thereby reducing the payment amount. If you have experienced similar issues, please complete the following short survey, which should take less than 15 minutes: Inquiries about Your Practice. Consider including your billing and coding staff in the survey.
   
   
2. In the second case, the North Carolina Foot and Ankle Society and South Carolina Podiatric Medical Association are seeking podiatrists nationwide who are experiencing issues with recoupment for skin substitute products. Medicare Advantage Organizations such as Humana MA are prohibited from placing coverage restrictions that are more restrictive than CMS coverage guidelines. Providers around the country have been experiencing a significant increase in denials for skin substitute products by Humana’s Medicare Advantage plan as Humana enforces Policy Number HUM-1208-000, a policy more restrictive than published Medicare coverage. Providers are considering filing a federal suit against Humana MA. If you have interest in participating in this suit, please email Stephen Bittingerat Polsinelli, PC, or call 440-823-0664. Participants must agree to join the proceeding by January 10, 2025.