NewsPoll: Providers receive some far-out denials

Friday, January 16, 2015

YARMOUTH, Maine – Imagine having a claim denied because Medicare doesn’t like the handwriting on the prescription.

That was the case for one provider who responded to a recent HME NewsPoll on audits, who was told the handwriting on the prescription didn’t match the doctor’s signature, and therefore it wasn’t valid.

“Medicare told us the medical prescription was written by a girl—‘we can tell,’” said the provider. “Since when did Medicare become a handwriting expert?”

The majority (72%) of respondents say they were audited more frequently in 2014 than 2013; 18% said they were audited less and 10% reported no change.

To that end, 72% of providers have dedicated more resources to deal with the onslaught of audits; 16% of respondents reported that they haven’t.

Respondents were also asked to share the most ridiculous reason they were denied.

Many reasons were due to a mistake on Medicare’s part. For example, one provider said, the agency had a beneficiary listed as dead, then alive, then dead again, while others challenged common sense.

Several providers reported receiving denials for wheelchairs for paraplegics and amputees, including one provider who said a power wheelchair for a paraplegic was denied because he also owned a truck. 

“But I don’t believe his truck would fit in his apartment,” said the provider.

A number of respondents expressed frustration about denials because contractors overlooked information. 

“A RAC audit stated the patient's weight was missing when it was there in three different places,” said Craig Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment. 

Also contributing to frustration: contractors not adhering to Medicare rules. One provider reported receiving a denial because the doctor didn’t include his credentials and the date next to his signature on the chart notes, even though the Medicare Program Integrity Manual said it was not required. 

As one provider put it, “Our favorite denials are the denials that aren't actually denials, but where the person auditing the information does not know Medicare policy and denies the claim in error.”