Working Down Denials

The denial reason code CO150 (Payment adjusted because the payer deems the information submitted does not support this level of service) is No. 5 on the list of RemitDATA‘s Top 10 denial codes for Medicare claims.

CO150 is associated with the remark code M3: Equipment is the same or similar to equipment already being used. Many of you are, unfortunately, very familiar with the “same and similar” denial.

This denial is very frustrating, as it means the patient has received this item in the past and not enough time has passed for the provider to bill Medicare for a new piece of equipment, or, the patient currently has the same or similar product. Providers see this denial code often on items such as walkers, commodes and wheelchairs.

For those of you who are pulling your hair out because of the same/similar denial, there is hope. All four of the DME MACs have provided suppliers with the ability to check through their Interactive Voice Response (IVR) systems whether patients have had equipment previously or currently have it. By utilizing this feature, you can reduce your CO150 denials with the frustrating M3 remark code. Call your jurisdiction’s IVR prior to dispensing the equipment so that an ABN can be obtained and the appropriate assignment decision can be made.

When calling the IVR, you will need the following information:

• National Provider Identifier (NPI)
• Provider Transaction Access Number (PTAN)
• Patient’s Medicare number
• Patient’s first and last name
• Patient’s date of birth
• HCPCS of equipment being provided

You will then need to access the “CMN Status” option on the IVR. This option provides information for all “Inexpensive or Routinely Purchased (IRP)” items and all rented items, including capped rental items and oxygen equipment, regardless of whether the equipment requires a physician-signed CMN or not.

Based on analysis of 5,933,366 claims adjudicated by the four DME MACs and processed for RemitDATA customers from July through September, 2008. Source: RemitDATA, 866/885-2974, www.remitdata.com

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. You can reach her at 419/448-5332 or [email protected].