While RemitDATA recorded a 17.6 percent denial rate from
Medicare for the E1390 (oxygen concentrator) for the first quarter
of this year, the company's customers fared much better than
providers overall who submitted these claims in Jurisdiction A.
Let's review the results of the DME MAC's prepayment complex
medical review of oxygen and oxygen equipment, posted June 8 on the
NHIC website (www.medicarenhic.com).
If a claim is selected in a prepayment complex medical review,
the DME MAC will send an additional documentation request (ADR) to
the provider requesting documentation to prove the validity of the
claim(s) submitted prior to adjudication. Once the documentation
has been reviewed, a decision of denial or payment is rendered.
NHIC's review was conducted on claims submitted from Jan. 1
through March 31 of 2010 based on the oxygen and oxygen equipment
LCD. The review involved 376 claims submitted by 39 suppliers. Of
those claims, 89 were allowed and 287 were denied, resulting in a
76.33 percent denial rate.
Based on its review of the documentation received, the DME MAC
gave the following as primary reasons for denial:
No in-person examination 30 days prior to date of initial CMN
(34.5 percent);
No in-person examination 90 days prior to date of
recertification CMN (12 percent);
Oxygen saturation level could not be validated (7.3
percent);
No initial CMN; only a recertification CMN completed and signed
according to the recertification date (1.5 percent);
Physician in-person visit or physician orders were illegible or
name stamped (1.4 percent);
Billed in error (1.4 percent); and
Section “D” of CMN (physician attestation section)
was not dated in an appropriate time frame or was dated before the
initial CMN or recertification date (0.7 percent).
When billing for oxygen and oxygen equipment, keep these reasons
for denial in mind and review your documentation to make sure you
have the information required to prove the medical necessity of
your claim.
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.
