Medicare denials for similar devices

Medicare denials for similar devices

MKShop

11/18/2003

We are a region C Medicare provider and are getting denials from Medicare because they say the patient has received a like or similar device. We were aware of the change coming and had the patient sign the appropriate form and filed with the appropriate modifiers that said we knew it may be denied. More often than not the patient received a walking boot, CAM walker if you prefer. Very often physicians will prescribe these for the short term, then, if appropriate, an AFO for long term use. Medicare then denies the AFO due to the patient possessing the boot.

I recently sent an appeal letter and have yet to hear back. I was wondering if all are having this problem and if any of you have had success on appeal. If you did, may I ask how you justified your appeal.

Any help would be appreciated. I will post replies with names omitted for those who may be interested. Thanks.

Kevin C. Matthews, CO/LO