C0175: Prescription is incomplete

C0175 — the fourth highest reason for Medicare claim denials reported by HME providers — is the denial code for: payment denied because the prescription is incomplete.

This code indicates that Medicare has a certificate of medical necessity on file but that the CMN has errors. An example of such an error might be an oxygen CMN that was transmitted with an 8.7% saturation, instead of 87%. To be certain, make a call to customer service in your region. (Also note that some providers in Region C have occasionally received this denial code to indicate a missing CMN rather than the C0176 denial code.)

A claim that has received a C0175 for an incomplete CMN should not be resubmitted. Medicare will not replace the incorrect CMN with a corrected CMN. The only way to correct this claim denial is to send a copy of the corrected CMN to redetermination.

A copy of the redetermination request form can be found on the Web sites for each region’s DME MAC/DMERC. Your request should ask that the correct CMN be loaded into Medicare’s common working file and that payment be made for the denied claim. Make sure that the request includes a copy of the denial as well as a copy of the correct CMN.

Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, and specializes in proper billing protocols, Medicare coverage guidelines and billing office procedures. She can be contacted at 419/448-5332 or [email protected].

Based on analysis of 3,680,443 claims adjudicated by the Medicare contractors between July 1, 2006, and Sept. 30, 2006, and processed for RemitDATA customers. Source: RemitDATA, 866/885-2974, www.remitdata.com.