Wiki appeal decisions

[mfinn]

medicare denied a claim for AFO same/similar. In Jan 2018, pt fx leg in 3 plc and rec'd DME. In April 2018 fx'd ankle and rec'd DME at Urgent Care. Appealed with reason that Dr treated current acute injury in good faith and wasn't aware pt had previous DME and it was not appropriate for this injury. None the less, it was still denied.. Now on to second level-- any suggestions???

 

[iowagirl77]

Hopefully an ABN was signed? You might try appealing based on a change in medical condition- see the attached from a DME webinar:
http://aapcperfect.s3.amazonaws.com/e7fe2e86-ee05-475b-ac2c-bdc28fea95c1/13d0939d-0a57-44a9-afea-3e1d6b349bb7/177474d8-73f6-4cb4-88b7-77fda2d11155.pdf