Author
Sarah Hanna
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].
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Working Down Denials
E0100 Cane, Adjustable/Fixed with Tips
Among the top denial reasons for E0100 claims, which have a 16.1% denial rate, are that the patient has "same or similar" equipment, is in a nursing home or on an inpatient hospital stay at the time of -
Working Down Denials
A4353 Intermittent Urinary Catheter
The overall Medicare denial rate for claims for A4353, intermittent urinary catheter, is 18.5 percent. -
A6243 Hydrogel Dressing
The A6243 — hydrogel dressing, wound cover, sterile pad, each — has an overall denial percentage of 19.4. -
Check New Rules On Removal of LCA
With the elimination of the least costly alternative (LCA) determination, the following rules apply under this new guidance: -
Documenting Therapeutic Shoes
Many providers have added therapeutic shoes for diabetics in recent years, but there are strict Medicare documentation requirements associated with providing the product. -
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A4623 (Tracheostomy, Inner Cannula) and A4629 (Tracheostomy Care Kit for Established Patients)
Based on the DME MAC's review of documentation received, the following were the two primary reasons for denial: -
K0823 Group 2 Standard Power Wheelchair
In a recent prepayment review of 1,000 claims for HCPCS K0823 in Jurisdiction A, NHIC found a 76.3 percent claim denial rate.