K0823 Group 2 standard power wheelchair

The month of May rings in a new winner in our DME “MAC Attack” for the highest denial rate on product code K0823 – Group 2 standard power wheelchair. NHIC Corp., the Jurisdiction A DME MAC, showed a 27.3 percent denial rate and now reigns as king of the denials comparison for the first time in 2008.

There seems to be no common thread to the denial reason codes among the four DME MACs regarding K0823 claims. The CO18 (duplicate claim) denial showed up as one of the top five reasons for denial in all jurisdictions. But the top reason code in Jurisdiction A was CO38, services not provided or authorized by designated (network/primary care) provider. The No. 2 reason code was CO150, payment adjusted because the payer deems the information submitted does not support this level of service.

The CO38 denial often occurs when a company’s supplier number is no longer active. Supplier numbers can become inactive when providers forget or miss the timeframe to complete their renewal application. If this happens to your organization, contact the National Supplier Clearinghouse (NSC) immediately to re-apply for your supplier number. (And remember that effective May 23, 2008, the identifier you use on all claims must be your NPI.) Once the issue has been resolved with the NSC, then your denied claims can be resubmitted for payment.

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 1,954,543 claims adjudicated by the four Medicare DME MACs and processed for RemitDATA customers in March 2008.

Source: RemitDATA, 866/885-2974, www.remitdata.com