Learn the Lessons of Palmetto Review
Published on Mon Jul 11, 2011
Perhaps because chest X-rays are so common, documentation for these services often isn't as meticulous as it should be. That means the documentation may not match up to payers' policy standards.Case in point: Palmetto GBA recently completed a review of 71010 and 71020 claims for November 2010 through January 2011 in Southern California. The Jurisdiction 1 Part B MAC reviewed 3,233 claims and denied 1,610 -- a 49 percent denial rate. Here is a look at the most common problems identified and the solutions Palmetto suggested.Problem/Solution 1: A whopping 42 percent of the denials were due to the service lacking the necessary provider's order. Palmetto suggests that providers be sure to include the order when they're asked to submit documentation to the payer. In addition, you need to be sure the order meets signature requirements.Problem/Solution 2: More than one-third of the denials were a result of the provider not submitting the [...]