Same or similar denials burn Region D providers

Wednesday, July 31, 2002

WASHINGTON - Region D denials for "same or similar" claims appear to be skyrocketing, according to one billing professional.

"It's a huge, huge problem," said Nancy Burma, president of Alternative Billing Solutions in Bloomington, Minn. "I can't tell you how many thousands of dollars we have written off on clients over the last six months. It's our No. 1 denial."

The reasons could be several, sources say:

- Beneficiaries have become more adept at working the system.

- Providers are busy and not spending enough time qualifying patients.

- Region D's doing a better job tracking claims.

The key to preventing or at least limiting the number of same or similar denials starts at intake by asking the beneficiary if he's had the same or similar piece of equipment in the last five years, say billing experts.

"A good front office, customer service guy should be able to figure it out right away," said Ward Cook, president of Allegro Medical Billing in Tampa, Fla.

"But if a beneficiary decides, for what ever reason, to lie, you are at his mercy," said Bruce Brothis, president of Centralized Billing & Intake in Parker, Colo.

"You are taking a blind faith order that this stuff is going to be covered," said Cliff Woolard, general manager of Home Med-Equip in Concord, Calif. "You are taking someone's word that they have never had this before."

The DMERCs don't release patient information to providers. If they did, HMEs could ascertain if a beneficiary previously received a same or similar piece of equipment. However, it's possible to cull that information by arranging a three-way conference call between the provider, patient and DMERC, Brothis said.

But since that's a time-consuming process, it's generally reserved for patients that somehow seem suspicious, Brothis said.

Nevertheless, some patient's will fall through the cracks.

"If a little old lady puts on a puffy face, you will not think twice about it," Brothis said. "You will get burned every now and then." HME