Study provides sobering look at Medicare billing problems

Monday, December 31, 2001

MEMPHIS, Tenn. - A new study that has aggregated remittance data from more than 240,000 Medicare claims has put ammunition behind HME claims that paperwork is the toughest part of being a provider.

For example, the RemitData study has found that:

- 6% of all claims are denied because they are duplicates of claims already adjudicated by the DMERCs.

- Medicare issues payment on 51.8% of claims submitted in 0-30 days. But almost 10% of all claims aren't paid until more than 181 days after the date of service.

- Four out of five K0009 wheelchairs are denied by the DMERCS. Almost one out of every two claims for repair or non-routine DME service is denied.

Late last month, the results of what may be the industry's first in-depth analysis of aggregated Medicare claims remittance data were landing on the desks of approximately 30 HME companies that have signed up to receive regular report cards from RemitData, based in Memphis.

Bently Goodwin, president and CEO of RemitData, says he believes his report may be the first broad-based analysis of Medicare claims ever conducted. (To receive a copy, go to

The study provides a sobering look at the typical HME dealer's business with Medicare, including analysis of DSOs by HCPCS, a break-down of the various reasons the DMERCS have denied claims, denial rates by HCPCS and a wealth of other data that providers are already using to retool their claims processing and fight the DMERCs.

"It'll give ammunition to come people," said Goodwin. "For example, the Region C DMERC has been telling one of my clients that not very many claims are getting COB17 denial codes. (COB17 points to CMN problems.) But actually, that's the second most common reason behind claims denials."

Access to the data is shedding light on problems that Kim Brummett never suspected were so large, and so small. For a long time, the director of reimbursment at Advanced Home Care in Greensboro, N.C. thought that one out of every two of her denials was the result of a duplicate claims.

"I thought it was huge," she said, "but it was only 11% of my denials." (Her C018 denial rate is twice as good as the typical HME's. The industry average is 22%.)

Knowing that her "same-similar" problem was not nearly as great as she'd imagined affected the way she trains new intake personnel. Instead of focusing on the same-similar hurdle, she began to focus on problems associated with claims that get the day-of-discharge wrong.

RemitData charges $2,500 per year for remittance analysis. Brummet thinks that's a deal since her reimbursement staff may now work their denials in 20 hours per week instead of 40.

Before Gary Morse signed up with RemitData, his claims processors worked their denials with paper remittances. "We were just working them one at a time, trying to correct one little thing at a time," said the v.p. of reimbursement at Roberts Home Medical in Germantown, Md.

At that pace, Roberts remittances never told a "story." Now it does, and Morse can tell how frequently he bills the wrong DMERC, where his intake personnal are askig the wrong questions and how badly his DSO is plagued by duplicates.

"We're doing duplicates, but everyone's doing it," he said. HME