NEW Inpatient Claim Edits-no 48 hour rule?

NEW Inpatient Claim Edits-no 48 hour rule?

Maggie Perez

12/4/2013

We have been experiencing many denials or actual recoupments for items that were fit in a facility utilizing the MCR 48 hour rule. In contacting our MCR customer service reps we are being told that the only thing we can do is a redetermination, which we tried but it denied as well. In talking to another MCR rep today I found out that there are new CMS edits regarding deliveries while inpatient and the MCR customer service staff have no idea why this is happening. They are instructed just to say that a redetermination needs to be done. WHY? We are following MCR's own protocol for billing for something fit with 48 hours of discharge. We should not have to go through an appeal, and in some cases, have money taken back from claims dated back to 2012. This just isn't right! According to the person I talked to, even her supervisor can not get answers from CMS. NO response at all. They have no idea what to tell providers. I refuse to have to do re-determinations on these and then have them deny anyway!! I am fighting this through corporate till I get someone to respond. How are others handling this?????

Maggie Perez
Office Manager
Capital O & P
246 Pleasant St
Concord, NH 03301
603-226-0106



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Capital Orthotics and Prosthetics, LLC
246 Pleasant Street, Suite 200, Concord, NH 03301
603-226-0106 / fax 603-226-0845
www.CapitalOandP.com