Eli's Rehab Report
Wound Therapy Claims May Go Under the Microscope
PDF
COLUMBIA, S.C. -- Watch for claim denials if you bill for negative pressure wound therapy. TriCenturion, the Program Safeguard Contractor for Jurisdiction A/B, has just issued a final report that cited a 75 percent denial rate on such claims. The report springs from a widespread prepayment probe by TriCenturion. The overall charge denial rate for the review was 75.55 percent. The contractor denied 41 percent of the claims because the medical information submitted didn't demonstrate the policy criteria. The most common problems were supplier-created forms submitted as a substitute for requested medical information, no medical information submitted, physician orders incomplete, no wound measurements documented, wound measurements unchanged from previous month, initial coverage criteria not met, and therapy lasting longer than four months. The report also notes that TriCenturion denied 30 percent of the claims for non-response to the request for documentation. To see the report, go to www.tricenturion.com/content/pcalpet.cfm.
Eli's Rehab Report
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