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Tag: Denial Rate

Craig Douglas

Specialty Providers

Stakeholders push back against vent denial rates 

August 15, 2023Theresa Flaherty, Managing Editor

WASHINGTON – With an “absurd” denial rate as high as 86% for non-invasive ventilators for one major Medicare Advantage plan, industry stakeholders are collaborating with patient advocacy groups to elevate their concerns with CMS.  Confusion around who qualifies for NIVs vs. bi-level devices is nothing new, but recently, it’s gotten worse, says David Chandler, senior director of payer relations for AAHomecare.  “It’s escalated to what I consider...

AAHomecare, Denial Rate, Medicare Advantage, Ventilator, VGM Group

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MACs ease denial process for oxygen claims

May 11, 2018HME News Staff

WASHINGTON - The DME MACs are adding modifiers that will allow HME providers to provide additional information related to the coverage and/or liability when the policy criteria are not met for oxygen patients. “The benefit of this change is that suppliers can now file an oxygen claim when a patient doesn't qualify and get an accurate PR (patient responsibility) denial,” AAHomecare wrote in a bulletin. Effective for claims with dates of service on or after Aug. 1, providers should...

Advance Beneficiary Notice (ABN), Denial Rate

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Demo allows providers to make their case by phone

March 8, 2016HME News Staff

JACKSONVILLE, Fla. - C2C Innovative Solutions, the Qualified Independent Contractor or QIC for the second level of Medicare appeals, is conducting a demonstration project that allows HME providers to discuss denied claims over the phone before a decision is made. The QIC is conducting the demo project in Jurisdictions C and D for diabetes testing supplies and oxygen equipment, according to its website. “The Formal Telephone Discussion Demonstration gives suppliers the opportunity to speak...

Denial Rate

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On the Editor's Desk

Swear words, celebrities and everyday people

March 19, 2015Liz Beaulieu, Editor

It's not uncommon for me to be at a loss for blog ideas. That's certainly the case this week, especially after Managing Editor Theresa used WTF in her blog (yes, I noticed) and Associate Editor Tracy cited a handful of celebrities in hers (ditto). How can I beat that? In all seriousness, this got me to thinking: What do you, dear reader, like reading about in blogs, anyway? So I logged in to the ever-helpful Google Analytics to find out what our most read blogs were so far this...

Denial Rate

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Guest Blog

Medicare sees a number, not someone's mother

January 30, 2015HME News Staff

I need to call a patient's family and tell them that I either have to pick up the hospital bed they are renting from me, or they have to sign a document that states they are willing to pay privately. I provided them a bed and the claim for that bed was randomly picked by the Medicare contractor Noridian to be audited. An audit of a claim should not scare anyone—you would expect that they look at the documentation and see if the patient needs the equipment. Well it does not work that...

Audit, Denial Rate, Medicare

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NewsPoll: Providers receive some far-out denials

January 16, 2015Tracy Orzel

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...

Audit, Denial Rate, HME NewsPoll, Medicare

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In brief: CMS awards new bid contracts, QIC overturns denials

April 18, 2014HME News Staff

HONOLULU - CMS has awarded new competitive bidding contracts to two local providers in Hawaii: Aloha Medical and American Home Care Systems. To date, just 13 of the 97 providers who accepted contracts as part of Round 2 of competitive bidding were located in Hawaii. The move is in response to concerns raised by the Hawaiian congressional delegation and the Healthcare Association of Hawaii (HAH) about decreased access to equipment and services. “We appreciate that CMS has taken a positive step...

Audit, Competitive Bidding, Denial Rate

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Audits: 'We are in crisis,' stakeholders say

February 14, 2014Theresa Flaherty, Managing Editor

WASHINGTON - HME stakeholders made their case against an audit program run amok at a forum last week. “We need to have a resolution on how to help my providers today because we are in crisis,” said Tom Ryan, president and CEO of AAHomecare, who attended the daylong event on Feb. 12. “The system is broken and it needs to be fixed.” The Office of Medicare Hearings and Appeals (OMHA) hosted the forum to discuss an increased workload that has led to a backlog of 460,000...

Backlog, Denial Rate, Forum

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Obscure court ruling could set powerful precedent

December 13, 2013Elizabeth Deprey

WASHINGTON - A 5th Circuit Court ruling over runny eggs could be just the ammunition HME providers need in cases involving ambiguous CMS guidelines. “People think this case is humorous because of the underlying facts, but it has implications for all types of Medicare providers,” said Edward Vishnevetsky, an associate with Munsch Hardt in Dallas. “This is the first time we've seen a court not defer to CMS's interpretations.” Prompting the ruling was an appeal...

Administrative Law Judge (ALJ), CMS, Denial Rate, Edward Vishnevetsky, Neil Caesar

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Also Noted

What's behind PMD demo denials?

November 5, 2013HME News Staff

INDIANAPOLIS - Prior authorization requests submitted as part of the PMD demo are being denied because of conflicting information in face-to-face examinations and other medical records, and insufficient face-to-face examination information, National Government Services announced in a recent bulletin. The list of reasons covers denials as of Oct. 24. NGS says face-to-face exams often do not specify: how a PMD will sufficiently improve the beneficiary's daily life; the patient's mobility limitations,...

Denial Rate, National Government Services (NGS)

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