Subscribe to RSS - denials


MACs ease denial process for oxygen claims


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.

Demo allows providers to make their case by phone


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.

Swear words, celebrities and everyday people

Thursday, March 19, 2015

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?


Medicare sees a number, not someone’s mother

Friday, January 30, 2015
Gary Rench

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.

NewsPoll: Providers receive some far-out denials


YARMOUTH, Maine – Imagine having a claim denied because Medicare doesn’t like the handwriting on the prescription.

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


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.

QIC overturns denials


WATERLOO, Iowa – Seventy-percent of the denials that U.S.

Audits: ‘We are in crisis,’ stakeholders say


WASHINGTON – HME stakeholders made their case against an audit program run amok at a forum last week.

Obscure court ruling could set powerful precedent


WASHINGTON – A 5th Circuit Court ruling over runny eggs could be just the ammunition HME providers need in cases involving ambiguous CMS guidelines.

What’s behind PMD demo denials?


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.