EO601 Continuous Positive Airway Pressure (CPAP) Device

EO601 Continuous Positive Airway Pressure (CPAP) Device

This month we had a close race for the top spot in our DME MAC denial comparison. National Government Services, the Jurisdiction B DME MAC, came in as our No. 1 with an 18.6 percent denial rate on E0601 — Continuous Positive Airway Pressure (CPAP) device.

The top denial code across all of the DME MACs was OA109 – Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

However, the one differential between Jurisdiction B and the other MACs is that the second highest denial code was CO150 — Payment adjusted because the payer deems the information submitted does not support this level of service. The second highest code for the other jurisdictions was CO18 — Duplicate claim.

In dealing with the OA109 denial, providers need to address the ways in which they are identifying the appropriate payer that must be billed. Online eligibility checks, copies of insurance cards, utilizing digital cameras in the field and verifying the patient’s permanent address are options that can assist in reducing this denial. When you receive this denial, contact your DME MAC for details about the denial that will assist in your resubmission of the claim.

Analyze your process for verifying eligibility and look for areas that can be improved. The OA109 denial is one that the billers cannot reduce without the assistance of intake and delivery.

Based on analysis of 1,826,949 claims adjudicated by the Medicare DME MACs and processed for RemitDATA customers in February 2008.

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