We currently have 3 claims that are going through the appeal process .Per Medicare the delivery receipts does not have the required details for Prosthetic Custom in house fabricated socket.
Our billing software Delivery receipts included the patient’s name, DOB, Insurance ID, all HCPCS codes and descriptions, quantities given, a description of the device, patient’s signature and date of signature. It also includes the components purchased for the prostheses (feet, knees, Shrinkers, socks, liners, from other supplier) on the receipts prior to the patient signing, but the claims were still denied. We were told that the delivery receipts are not detailed enough. After the denial We outlined in an attestation letter each and every component and all material that went into the construction of the custom sockets and had the patient sign that and it still wasn’t good enough for Medicare. We are ready now to to go to Reconsideration, We don’t want to take any chances of having the claims not getting paid at this level of appeal because we don’t want them to get stuck in the ALJ stage.
Does anyone have any experience with this level of appeal with this kind of delivery ticket issue and have you gotten your claims paid?
We will really appreciate your suggestions .
Regards
Zia ur Rahman BOCPO
Michigan.
