Medicare denials
Cindy Anderson
Description
Collection
Title:
Medicare denials
Creator:
Cindy Anderson
Date:
2/12/2014
Text:
Starting in September we began receiving denials from Medicare for L1930, L1960, L1970 & L1932 when delivered two days prior to discharge to home, billing date being the date of discharge, with a CO-97 denial. This benefit for this service is included in the payment/allowance for another service/proceedure that has already been adjudicated.
I spoke with two level 2 Medicare reps who stated the patients were dischaged to home under home healthcare, the hospital bills they received discharged the patient as an 06 to home healthcare rather than an 01 to home. When the patient is discharged to home healthcare Medicare has no jurisdiction to pay and the facility is responsible for payment. One facility understood the explanation and paid the claim.
The Medicare rep also said it could possibly be a glitch in the system. She called me two weeks later to say she had no update and suggested I file a redetermination. I believe they will just find some other reason to deny payment at that point. I contacted Joe at AOPA and he hadn't heard about this from any other providers.
Has anyone else experienced the same situation and if so, were you able to resolve it without filing a redetermination? Any assistance would be greatly appreciated.
Stay out of the snow!
Cindy Anderson
Manfredi Orthotic & Prosthetic Affiliates
Billing Dept.
<Email Address Redacted>
I spoke with two level 2 Medicare reps who stated the patients were dischaged to home under home healthcare, the hospital bills they received discharged the patient as an 06 to home healthcare rather than an 01 to home. When the patient is discharged to home healthcare Medicare has no jurisdiction to pay and the facility is responsible for payment. One facility understood the explanation and paid the claim.
The Medicare rep also said it could possibly be a glitch in the system. She called me two weeks later to say she had no update and suggested I file a redetermination. I believe they will just find some other reason to deny payment at that point. I contacted Joe at AOPA and he hadn't heard about this from any other providers.
Has anyone else experienced the same situation and if so, were you able to resolve it without filing a redetermination? Any assistance would be greatly appreciated.
Stay out of the snow!
Cindy Anderson
Manfredi Orthotic & Prosthetic Affiliates
Billing Dept.
<Email Address Redacted>
Citation
Cindy Anderson, “Medicare denials,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236063.
