Home Health & Hospice Week

Be vigilant to prevent unnecessary denials.

If you're a supplier of power mobility devices, your bottom line may be dogged by more than just Medicare's new PMD fee schedule.

Contractors charged with implementing the Centers for Medicare & Medicaid Services' new codes for power wheelchairs haven't aced the transition from Medicare's old four-code system to the program's 64 new codes.

For suppliers, the rough spots since the Nov. 15 code implementation have led to unnecessary denials, reports Eric Sokol of the Power Mobility Coalition.

Claims with a number of the new Healthcare Common Procedure Coding System (HCPCS) codes have been routinely denied in error--and must be resubmitted, Sokol cautions.

Lesson learned: Review all claim denials carefully in the coming months, particularly those that came in the first 90 days of the new system. If a coding conflict is to blame, resubmit the claim for reconsideration.

The durable medical equipment Medicare Administrative Contractors (DME MACs) have worked though most of the problems, says Sokol. But suppliers will still have to weather the payment delays as claims are reprocessed.

Suppliers in Region D have been hardest hit, though suppliers in Region A have also reported unnecessary denials. Region A includes Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.

Region D encompasses the states of Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming as well as American Samoa, Guam and the Northern Mariana Islands.

Raw deal: Suppliers can't expect the DME MACs to pay any interest on the late payments.