Denied lockig gel liners
Dale Anderson
Description
Collection
Title:
Denied lockig gel liners
Creator:
Dale Anderson
Date:
12/19/2012
Text:
Dear List:
We recently received a payment denial from Noridian, region D, for replacement Locking gel liners.
The patient first received liners in July, we replaced these worn liners in November. We sent patient to his physician to document need. Photographed worn liners to document their wear. Charted all pertainent information.
Noridian denied payment stating that liners were denied due to several reasons.
1st that the information submitted does not support this level of service.
2nd This denial is based on LCD.
I have not seen any information in the LCD that specifically addresses locking gel liner replacement.
We phoned Noridian and customer service states that the denial was for over utilization based on unpublished information for quantity limits, a patient is only able to receive new liners with in a specific time frame. She would not tell us how we can access this unpublished information other then stating we would have to contact CMS directly. I have a good idea how that conversation will go.
Is anyone on the list aware of this and/or other unpublished information ?
How are others dealing with these denials ?
Dale Anderson CPO
We recently received a payment denial from Noridian, region D, for replacement Locking gel liners.
The patient first received liners in July, we replaced these worn liners in November. We sent patient to his physician to document need. Photographed worn liners to document their wear. Charted all pertainent information.
Noridian denied payment stating that liners were denied due to several reasons.
1st that the information submitted does not support this level of service.
2nd This denial is based on LCD.
I have not seen any information in the LCD that specifically addresses locking gel liner replacement.
We phoned Noridian and customer service states that the denial was for over utilization based on unpublished information for quantity limits, a patient is only able to receive new liners with in a specific time frame. She would not tell us how we can access this unpublished information other then stating we would have to contact CMS directly. I have a good idea how that conversation will go.
Is anyone on the list aware of this and/or other unpublished information ?
How are others dealing with these denials ?
Dale Anderson CPO
Citation
Dale Anderson, “Denied lockig gel liners,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/234357.
