Lymphedema Insurance Coverage Video and Interviews
By Robert "Bob" Weiss, M.S.

My presentation at the Colorado Lymphedema Awareness Day celebration in Wheat Ridge, CO in March 2012 "Lymphedema Reimbursement Issues — A Primer on Health Insurance, Medicare Coverage", At a number of subsequent meetings in 2012 I presented a Medicare update "2012 Medicare Changes That May Affect Lymphedema Stakeholders". The content of these two presentations have been combined into a single video presentation, and is being made available courtesy of Guenter Klose, Founder and Executive Director of Klose Training & Consulting.

Major value was added to the video in a segment where I am interviewed by Guenter and asked to address many of the concerns of a lymphedema therapist and trainer about Medicare and private insurance reimbursement, claims processing and appeals. In another segment Guenter interviews Mary Rosenberg PT, CLT-LANA, proprietor of Hollywood Therapy Associates in Hollywood, CA on reimbursement and treatment issues from a therapist's and business owner's point of view. The video, LYMPHEDEMA MEDICARE COVERAGE AND REIMBURSEMENT comprises three major sections.

Introduction - Guenter Klose, Robert Weiss and Pearl Weiss

Introduction of lymphedema advocate Robert Weiss and his wife, lymphedema patient, Pearl Weiss, with a brief history of Pearl's lymphedema and Robert's advocacy.

Subparts 1-7 - R. Weiss: A Primer on Health Insurance, Medicare Coverage and Reimbursement

This 77-minute presentation follows my Colorado Lymphedema Awareness Day lecture with updated information on Medicare lymphedema coverage for 2012. A Microsoft PowerPoint version of my presentation is available for downloading, which can be viewed during my talk or studied afterward.

Subparts 1-5 - Guenter Klose and Robert Weiss: Questions and Answers

In this 46-minute interview with Guenter, I answer questions and expand on issues not covered in my original presentation, but which are of concern to him as a lymphedema management instructor and therapist, and to many of his patients. Guenter asked questions of concern to therapists, such as coverage and coding for bandaging and patient education, therapy caps and the exception process, and the importance of filing a claim correctly the first time.

Guenter, the Director of a therapist training school, is concerned about issues relating to the role of lymphedema-trained Licensed Massage Therapists as providers of lymphedema therapy services, and I give a history of this issue and outline a plan of action which might be followed by NALEA and LANA to achieve a solution.

Patient issues are discussed, including where a non-Medicare private insurance member can seek help in disputes with insurance companies, how a Medicare beneficiary can file a claim, and how to file a successful appeal.

The interview concludes with a discussion of the patient's role in advocating for public policy change and my multiple-approach strategy of negotiating CMS policy change within current law and pursuing a parallel course of legislation to change the law governing lymphedema treatment. We end with my motto:

Lymphedema treatment is good business as well as good medicine.

Subparts 6-7 - Guenter Klose and Mary Rosenberg: Interview

The video concludes with a 23-minute interview with Mary Rosenberg, PT, CLT-LANA (who graciously offered her Hollywood Physical Therapy Associates office for the video taping) on reimbursement from the perspective of a physical therapist in private practice. Mary covers the full spectrum of reimbursement policies she has encountered in Los Angeles, from the full coverage of provided therapy services and compression bandages and garments by Kaiser Permanente, to the flat-rate limited coverage policy of an un-named provider.

Mary discusses compression materials coverage, the advantages of working with case managers and lymphedema-qualified reimbursement specialists, the impact of therapy caps and the exception process, and how to start a lymphedema therapy clinic. Improving patient adherence and increasing treatment success rates are high on the list of therapists' concerns. Mary concludes with the advice that:

A comprehensive approach is the only effective way to have a successful outcome.

ACCESS TO THE VIDEO

Access to this free Edu-Session and the Powerpoint download is from the Klose Training web site http://www.klosetraining.com. Look for "Edu-Session I, Lymphedema Medicare Coverage and Reimbursement, Robert Weiss MS, Lymphactivist". Navigate to the Free Edu-Session page and register with the Get Access to All Edu-Sessions link at the bottom of the page. You will receive an e-mail response with a unique UserName and Password which is used at web page http://klosetrainingonline.com.

Left to Right: Guenter Klose, Robert Weiss, Pearl Hiat Weiss

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Lymphedema Treatment is Good Business as well as Good Medicine
© 2002 Robert Weiss, Porter Ranch, CA