Working Down Denials

With the advent of competitive bidding, many providers have changed their focus from traditional DME and respiratory products to supply items. 
However, suppliers need to be aware that the DME MAC’s... Read more >
Our industry has been aware of the impending Medicare Provider Enrollment, Chain and Ownership System (PECOS) implementation. With the implementation of Phase 2 that began on Jan. 6, 2014, suppliers... Read more >
The HME industry has been hit hard with audits and Additional Documentation Requests (ADRs) from Medicare. The administrative cost 
involved with getting claims out of the door has drastically... Read more >
The data has been analyzed, the reports have been completed and the results are in. RemitDATA has provided the information which has given us our product of the month, and the lucky winner is—... Read more >
This month we’re going discuss the K0858, power wheelchair, group 3 heavy duty, single power option, patient weight 301 to 450 pounds. The K0858 has an overall denial rate of 30.6 percent. One... Read more >
The leaves’ colors changing to beautiful reds, yellows and oranges signals the fall season. Winter follows and with it come increases in respiratory conditions in the people we serve. This... Read more >
Our industry faces new challenges daily, such as the new resupply regulations and contacting patients by the Centers for Medicare & Medicaid Services (CMS). Let’s look at the A4377,... Read more >
Wheelchairs are a challenging item for providers to prove medical necessity and the viability of the claim that is billed to Medicare. The burden of proof is on the provider of the product, not the... Read more >
The E0470 (Respiratory Assist Device, bi-level pressure capability, without backup rate feature) can be covered by Medicare for patients with a diagnosis of obstructive sleep apnea (OSA). Medicare... Read more >
How are your enteral denials looking? For some Medicare enteral providers, it’s not looking good. According to our friends at RemitDATA, the B9000 enteral nutrition infusion pump (without... Read more >
As patients become eligible for Medicare, they may be using equipment paid for by previous primary insurance. Denials can occur when the equipment must be serviced with new items, as is often the... Read more >
This month we will look at two tracheostomy items that have been hit with high rates of denial and are causing providers major headaches. RemitDATA has provided overall denial rate information... Read more >
For many providers, oxygen is the lifeblood of their revenue cycle. But Medicare is making it increasingly difficult to keep the oxygen cash flow in a positive state. We have CERT, pre-pay... Read more >
It’s the start of a new year, and many of us begin with a resolution. What was yours? Was it personal, did it involve business or was it both?  Well, if you are looking for ideas, please... Read more >
July brings with it summer gatherings with friends and family. Many of our patients want to enjoy those gatherings, and to do so, they may need ambulatory equipment to help. The item that we are... Read more >