Q. How can I avoid getting denials from Medicare for same or similar equipment? I'm especially concerned now that oxygen caps at 36 months.
A. Same or similar denials occur quite frequently among providers. This may seem like a difficult denial to avoid. However, with diligent up-front processes, you can protect your cash flow.
The first step is to ask the patient if he has ever had the equipment before or something similar. Be sure to gather information on what equipment he had, when and where he got it, if it was returned, and why he needed this equipment if he had same or similar equipment in the past. You may also contact Medicare for information. Each MAC handles this a little differently, some offering more options than in the past. For example, Region B offers an automated way to determine what CMNs are in the common working file. This allows you to find out the original oxygen start date and, as a bonus, the recertification date.
So what do you do with this information? In the case of oxygen, keep in mind that the clock started ticking for the cap on Jan. 1, 2006. Therefore, before taking on a switch-out patient, you want to make sure you are not going to lose money. To do this, calculate what your total reimbursement is going to be based on the time remaining in the cap.
Once you know a patient had same or similar equipment, use the advanced beneficiary notice. This allows you to alert the patient that he may be financially responsible. You may also collect the money up front and file the claim non-assigned. If the patient has had a change in condition or if there has been a break in service of at least 60 days, include something brief in the narrative field of the claim to avoid a denial. Lost, stolen, broken and obsolete equipment replacements may also be paid with supporting documentation. hme
Lisa Bargmann is president of Bargmann Management LLC and Homecare Collection Service. Reach her at 440-225-8299 or firstname.lastname@example.org.