Tag: Overturn

YARMOUTH, Maine - HME providers say they've had some luck getting Medicare contractors to reopen and overturn denials, but it's not always easy.The vast majority (96%) of the 49 respondents to a recent HME Newspoll said they have made attempts to get Medicare contractors to reopen claims denied for technical reasons. Sixty percent said they succeeded and, of those, 80% said their denials were, ultimately, overturned.“We have had as many as 16 claims processed incorrectly as recent as April,”...

WASHINGTON - HME industry stakeholders are seeing their first real sign of relief in the fight against audits.As a result of discussions with the Jurisdiction D DME Advisory Council (DAC), CMS has reminded its contractors that their “scope of services” includes reopening cases where claims have been denied due to technical reasons. That has opened the door for council members Peggy Walker and Mary Stoner to get more than 70% of the denied claims they submitted for reopening overturned.“This...

WATERLOO, Iowa - Seventy-percent of the denials that U.S. Rehab's Peggy Walker sent to C2C Solutions for review following a forum hosted by the Office of Medicare Hearings and Appeals (OMHA) have been overturned fully or partially in favor of providers. C2C Solutions is a Qualified Independent Contractor (QIC) that handles the second level of appeals. “C2C Solutions was willing to look over the denials that were made in error,” Walker said. “The errors were technical errors that...