According to some great information RemitDATA has provided, the overall denial rate for the E0143 (walker, folding, wheeled, adjustable or fixed height) is 19.3 percent. The top two denial reason codes are OA109 with an MA101 remark code (Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor) and CO60 (Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services). These codes are commonly attributed to the patient's being in a skilled nursing facility (SNF) or on an inpatient stay (hospital) at the time of service.
These denials traditionally occur because the equipment was delivered in anticipation of discharge. There are two possible reasons why this denial could occur for providers:
The date of delivery was entered into the software rather than the date of discharge.
The patient was not discharged on the anticipated date.
Medicare allows the following in the case of the first situation:
You may deliver a DMEPOS item to a beneficiary in a hospital or nursing facility for the purpose of fitting or training the beneficiary in the proper use of the item.
This may be done up to two days prior to the beneficiary's anticipated discharge to his or her home.
If it is the case that you billed in error with the date of delivery rather than the date of discharge, you have the opportunity to resubmit the claim with the date of discharge. Remember, though, that the timeframe between delivery and discharge may be no more than two days. Ensuring that your data entry personnel are entering the correct date into the system will help to reduce the possibility of denial for this reason.
If your claim fell into the second scenario, Medicare suggests that you pick up your equipment and redeliver either within two days of discharge or subsequent to discharge. You will not be reimbursed for the first delivery. Taking reasonable steps to verify the actual discharge date of the beneficiary will assist in deterring the likelihood of denial.
Analyzing your denials in order to affect change in your internal processes will add cash to your bottom line.
Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, specializing in proper billing protocols, Medicare coverage guidelines and billing office procedures. You can reach her at 419/448-5332 or firstname.lastname@example.org.
Based on anlysis of 55,129 Medicare claims for E0143 from RemitDATA customers during the fourth quarter of 2010. Source: RemitDATA, 866/885-2974 or www.remitdata.com