CMN and DIF Denials Cost Suppliers, Jurisdiction D Says

FARGO, N.D.–Recent analysis of claim denials show a high number
of claims denied for Certification of Medical Necessity (CMN) or
DME Information Form (DIF) issues, Noridian Administrative
Services, the Jurisdiction D DME MAC, notified providers last
week.

The percentage of claims being appealed for these denials is
estimated at 35 percent of the appeals workload, or 18,233 appeals.
The average cost of these denials for one year is approximately
$1.4 million, NAS said.

The denials are for services including parenteral and enteral
nutrition, infusion pumps and oxygen equipment. A CMN or a DIF is
required for these services for the initial claim and for revision
and recertification situations, the DME MAC reminded.

Noridian suggests the following tips to ensure claims will not
deny for CMN or DIF issues:

• Always check beneficiary history to see if another supplier
  already has a CMN or a DIF on file by asking the beneficiary if
  another supplier has previously provided the services in question
  or by calling the Interactive Voice Recognition (IVR) system to
  research this information.
• Always submit the CMN or DIF with the initial claim.
• Verify the initial claim is correctly processed before
  submitting subsequent claims.
• Make sure all necessary information is present on the CMN or
  DIF.
• Make sure the ordering physician or medical professional has
  signed and dated the CMN.
• Submit claims in chronological order.
• Failure to follow these tips may result in a CMN or DIF related
  denial. When a CMN/DIF is not filed with the initial claim, it will
  cause denials for subsequent claims.

Not only do the claims deny, Noridian said, but suppliers spend
a great amount of money requesting appeals. NAS estimates that it
costs suppliers an average $36.74 for an appeal, including
preparation and pulling supporting documentation, mailing/faxing
costs and the employee wages to request and track appeals.

View the
full notice.