FARGO, N.D.--Recent analysis of claim denials show a high number of claims denied for Certification of Medical Necessity (CMN) or DME Information Form (DIF) issues, Noridian Administrative Services, the Jurisdiction D DME MAC, notified providers last week.
The percentage of claims being appealed for these denials is estimated at 35 percent of the appeals workload, or 18,233 appeals. The average cost of these denials for one year is approximately $1.4 million, NAS said.
The denials are for services including parenteral and enteral nutrition, infusion pumps and oxygen equipment. A CMN or a DIF is required for these services for the initial claim and for revision and recertification situations, the DME MAC reminded.
Noridian suggests the following tips to ensure claims will not deny for CMN or DIF issues:
- Always check beneficiary history to see if another supplier already has a CMN or a DIF on file by asking the beneficiary if another supplier has previously provided the services in question or by calling the Interactive Voice Recognition (IVR) system to research this information.
- Always submit the CMN or DIF with the initial claim.
- Verify the initial claim is correctly processed before submitting subsequent claims.
- Make sure all necessary information is present on the CMN or DIF.
- Make sure the ordering physician or medical professional has signed and dated the CMN.
- Submit claims in chronological order.
- Failure to follow these tips may result in a CMN or DIF related denial. When a CMN/DIF is not filed with the initial claim, it will cause denials for subsequent claims.
Not only do the claims deny, Noridian said, but suppliers spend a great amount of money requesting appeals. NAS estimates that it costs suppliers an average $36.74 for an appeal, including preparation and pulling supporting documentation, mailing/faxing costs and the employee wages to request and track appeals.
View the full notice.