FINALLY - MEDICARE RESPONSE

FINALLY - MEDICARE RESPONSE

Karen Schebesta, Office Manager

Well I have finally received a response from Medicare as to why they are
denying various quantities on particular codes (L5685, L2820, etc.)
 
They have told me the following:
 
We now have medically unlikely edit guidelines that have not been made
public nor are they documented in any provider communications.
 
I was also told by a senior representative that we should APPEAL each and
every denial for quantity. Medicare is in the process of analyzing the
quantities of particular codes and will be MODIFYING the guidelines according to the
appeals. So in essence he told me, the more we write in for appeals, the
better chance they will change the guideline. He suggested that we just make
up a generic letter for each code and keep sending them in. If we dont
appeal, then we are showing that its okay not to pay them.
 
Any questions, let me know.................
 
Have a great week!!!
 

 
Karen Donohue

Karen A. Donohue, CPC, RMF
Office Manager/Certified Mastectomy Fitter
Orthotic and Prosthetic Center
1228 Route 37 West
Toms River, NJ 08755
Tel. 732-341-9191
Fax 732-341-9222
<Email Address Redacted>

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