Sorry for any confusion as I did not restate my question. I was asking if anyone in Region C could help me figure out why claims were starting to get denied by Medicare on quite a routine basis.
> Restating the question would be nice, as there are many questions
> posted and could be confusing. Thanks
>
> —–Original Message—–
> From: Kim Edgar [mailto:[email protected]]
> Sent: Thursday, May 06, 2004 7:42 AM
> To: [email protected]
> Subject: [OANDP-L] Region C helps Region A
>
>
> Here is a list of responses that I received. Hope this helps everyone
> as it helped me.
>
> ________________________________________________________________
> what codes are you using? are you getting any medical necessity
> documentation requests? Region C is currently going through probe
> audits and we are in Region C.
> ________________________________________________________________
>
> It is the new rule deny everything. LOLYoull need to send Medical
> records for the date the Rx was written, and a prior visit as well.
> Progress notes to show progression of the disease which requires
> bracing. Letter of medical nessity, with diagnosis, bracing
> prescribed, length of time braceing required, and reason why custom
> fabricated is required.
> It gets worse we have to do this for every custom device we fit!!! We
> have stoped taking assingment on any custom device. We file for the
> patient and even file apeals but we are a small company
> __________________________________________________________________
>
> Kim we have had similar denials from region B. When I call them they
> tell me I need more numbers in the ICD9 diagnosis code. They want a 5
> digit number not just a 4 digit number. Get a new ICD9 code book, the
> new numbers are in the latest version. Good luck
> __________________________________________________________________
>
> We are haveing a terrible time. Please post any help you get. Thank
> you __________________________________________________________________
> What are all of the codes associated with your denials, i.e.: MA13,
> M81, MA130, CO96, etc.? Region C certainly has been picky lately!
> __________________________________________________________________
> get in touch with your ombudsperson and have them research it – in
> Region A it turned out the claims were missing one or two items that
> were never required in previous years so they got rejected entirely.
> If you are doing paper claims or electronic it matters how you fill
> things out. Also, did you try calling claims to ask them
> __________________________________________________________________
> If you billed Region C and claim was denied for lack of information it
> usually means they believe the patient received a similar device
> within the last 5 years. They want to know why the patient needs a
> new device to determine whether these services should be covered (see
> 5-year rule for orthotic devices).
> If you file electronic claims you can submit this info with the claim,
> otherwise you have to submit a review request with all your
> documentation. Call me if you need more info.
> __________________________________________________________________
> Basically,you can give the best documentation ,physician’s
> notes,pictures of the braces,testimonials of the patient and
> PTs,detailed fabrication notes and invoices on each thing that was
> used in the casting to construction and to fitting of this device and
> you will never get paid.You will get nice letters from CMS that say
> you need this and that and still we more than likely won’t pay the
> bill.You have no choice but to call it a loss.Don’t give up billing or
> start using off the shelf,that is what they want you to do.This is a
> ploy to make all of our coding a base code with no options type
> settings.One stop shop for bankruptcy.I personally make it a goal of
> mine to provide each patient with the proper device for the situation
> but now the only thing I can do is explain how I can’t give them what
> they are used to because it might send me to the cleaners.Try,never
> give up,something will have to be done and maybe we might come out
> employed.If we had proper representation,our field wouldn’t need email
> like this ,we would be getting the increases of the PTs and MDs.I
> guess we have to hire their lobbyists to get anything done and let
> ours stay focused on the alphabet wars.Good luck,you are going to need it.
> ___________________________________________________________________
>
> That was all my replies, thanks again to all that responded.
>
> Kim Edgar,
> Office Manager
>
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