Looking at Medicare denial percentages for the E0607, home blood glucose monitor, the high numbers have held steady at 35 percent in 2009 and 35.3 percent for the first quarter of 2010. What does this tell you? It tells me that we haven't learned much from our mistakes. Is this because we can't teach old dogs new tricks? Is the reason because we were just too busy to pay attention and kept processing claims without regard to history? Or is it because we just don't care about cash flow? I know that can't be it, but often it's difficult to implement change when other issues within the operation steal our attention.
Well, today is the day to start paying attention and figure out why these denials are averaging 35 percent for the second year in a row. One particular point to note is that three of the top denial reasons for the E0607 are associated with “same or similar” denial codes.
The same or similar denial is one that has to be addressed at intake. Take the time to train your staff on their responsibility, and make sure they know how to check whether a patient has had the same or similar piece of equipment in the past. If intake personnel continue to bypass the same or similar status check, then disciplinary actions need to be taken.
There are three ways to check whether a patient has had same or similar equipment:
- Via the Interactive Voice Response (IVR) system through your
DME MAC
You can find instructions on how to use the IVR system through your DME MAC website, which has IVR User Guides that detail the information you need to access the same or similar database. There is no cost when using this option.
- Utilizing the Claim Status Inquiry (CSI) feature through
your DME MAC
This feature requires you to select a network service vendor that is contracted with your MAC to provide CSI online services. See your DME MAC website for a list of these network vendors. There is a cost associated with this option that varies among vendors.
- Some software companies have developed online status checks
through their systems
Check with your software vendor to see if this is an option and whether a fee is involved.
Bottom line, no one is making money at a 35 percent denial rate. In order to improve that number, we need to change our old ways and focus on improvement. Let's learn from our mistakes and limit these errors in the future.
Based on analysis of 8,945,016 claims processed for RemitDATA customers during the first quarter of 2010. Source: RemitDATA, 866/885-2974, www.remitdata.com
Read more Working Down Denials columns.
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 sarahhanna@bright.net.
