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Hello, OIG?

Special fraud alert on telemarketing just doesn't make sense.

Washington Wisdom by Cara C. Bachenheimer

Choose Your Own Terms

And don't blame everything on Walmart.

Better Business by Wallace Weeks

Move into Action

Make sure your 2010 to-do list doesn't turn into a 'didn't-do' list.

Sales Notebook by Louis Feuer

Time Flies

Is it time to conduct your annual performance evaluations?

Accreditation Now by Mary Ellen Conway

RAC 'Em Up

The permanent RAC program has now rolled out.

Law School by Jeffrey S. Baird

Current Issue

Cover Story

Still Betting on Sleep Therapy

Following CMS' new coverage mandates, a recent survey shows providers are working harder with patients all the way.

Marketplace

CMS Establishes Denial Codes for Processing NCB Claims

BALTIMORE--In a Change Request sent to the DME MACs on Friday, CMS established a number of denial reason codes to be used when processing claims under national competitive bidding.

Among the new denial codes:

--45: "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangment," to be used when the submitted charge on the claim is higher than the allowed charge; and
--96: "Non-covered charge(s)," to be used when denying claims for a beneficiary who resides in a CBA who obtains an item from a non-contract supplier that has not obtained a signed ABN.

The Change Request, No. 6069, noted three new reason codes when denying claims under NCB where a contract suplier submits a claim for oxygen equipment after the payment cap has been reached (maximum of 45 total payments for the beneficiary), or when the payment cap for a capped rental item has been reached (maximum of 25 total payments for the beneficiary):

--B7: "This provider was not certified/eligible to be paid for this procedure/service on this date of service."
--N211: "Alert: You may not appeal this decision."
--N307: "Billing exceeds the rental months covered/approved by the payer."

The new denial codes are effective July 1 with an implementation date of July 7, according to the Change Request.

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