Wiki Information regarding Denials, (Medicare and Medicaid)

[siddharthaqa@rediffmail.com]

Can anyone please give me the information regarding Medicare and Medicaid denials, NCCI edits, MUI, LCD, NCD, different kinds of denials with examples for the interview preparation for a position that needs in-depth knowledge about denial management for Medicare and Medicaid?

Thanks in advance for any help/advice.

 

[csperoni]

Don't mean to rain on your parade, but if the position requires in-depth knowledge, then you should already have in-depth knowledge. If you are not able to already discuss these items in the interview, then I don't know how you would do the day to day responsibilities.
The items you listed here are dictionaries of information if you are not already familiar with them. Good luck!

 

[siddharthaqa@rediffmail.com]

Of course, it is understandable that I have good knowledge about these topics that why I have applied. It's always better to be open-minded and positive, I think that's how you learn. Someone might come up with some great information that can be very helpful for everyone.

S.Roy, CPC, CIRCC

 

[sahni.vani@gmail.com]

here you go ---
1. Procedures is inconsistent with Modifier used or a required modifier missing .
2. Services not provided or authorized by designated providers
3. procedure / treatment is deemed experimental / investigational by payer
4. incorrect POS
4. Higher Severity admissions with lower Dx
5. Bundled services -- upcoding issues
6. Incorrect Medical necessity

 

[siddharthaqa@rediffmail.com]

Thank you, Vani

 

[wynonna]

MUE (medically/Medicare unlikely edits) means only 1 unit will be paid for, so bill only 1 unit.