Tag: Denial Rate

A claim review of the initial month of therapy for CPAP devices (E0601) for Oct. 1, 2013, to Dec. 31, 2013, showed a denial rate of 48%. In the previous quarter, the rate was 56%. The most common reason for denial: The documentation did not include a copy of a board certified document, screen print from a national certification agency, etc., that verifies that the physician who interpreted the sleep test met policy requirements (30%)…A claim review for oxygen concentrators (E1390) for Oct. 1, 2013,...

WASHINGTON - CGS, the Jurisdiction D DME MAC, released an overview of its K0823 prepay review activity this month, and the results are ugly.From the second quarter of 2012 to the second quarter of 2013, the denial rate rose steadily until hitting a peak of 69%. The denial rate fell to 54% for the third quarter of 2013—not much better.These rates transcend jurisdictions, stakeholders say, and are especially troubling considering all of the other pressures that HME providers face in today's market.“No...