Mastering Medicare Denials: A Comprehensive Guide by Argosy Group

1. ”Tuesday at 10 “ September 9, 2014 Working a Medicare “CO” Denial Presented by Argosy Group, Inc Tel: 888-691-2746 info@argosygroup.org

2. Disclaimer • It is the intent of the Argosy Group to provide up to date, accurate information . The information contained in this presentation is for educational purposes only and is not presented as legal advice or with any expressed or implied warranty of accuracy. • Argosy Group encourages you to visit and communicate with your Medicare Regional DMEMAC and your Accreditation Agency often

3. “CO” DenialsContractual Obligation • ANSI denial codes are identified on the remittance advice for each claim line • ANSI codes are used to convey appeals information, claim-specific information, additional explanation for claim-level adjustments • CO = Contractual Obligation The buck stops with the provider of service(s) Provider CANNOT just pass charges to private or other payer Must be corrected, resubmitted, re-opened, appealed or absorbed

4. Common “CO” Denials • CO-18 Duplicate claim (allow 14 days for electronic claims before re-submitting) Utilize DMEPAC Claim Status Inquiry Address the original claim (appeal or resubmit with necessary) information • CO-151 Payer deems information submitted does not support this level of service, many services, length of service, dosage, or day’s supply Commonly associated with “same/similar” Review “remark” codes to drill down to specific issue

5. Common “CO” Denials • OA-109 Claim not covered by this payer. You must send claim to correct payer (e.g. Another Medicare jurisdiction, Medicare Replacement Plan or altogether different primary payor) Claims are processed based on beneficiaries address on file with Social Security. Verify address used on the claim is the same address on file with SSA Electronic claims will transfer to correct Jurisdiction; however provider must have a signed EDI enrollment on file with that Jurisdiction for the claim to be processed

6. Common “CO” Denials • CO-176 Payment denied because prescription is not current Verify requirements for initial, revised or recertification (CMN) Check CMN status (those on file) with Medicare to see if another provider may be involved Ensure all sections of a CMN are completed prior to submitting Submit CMN with initial claim ONLY Wait 24-48 hours before submitting subsequent claims

7. Common “CO” Denials • CO-13 Date of death precedes the date of service Medicare Part B coverage was not valid when the patient received this item/service After coverage was terminated Prior to coverage Date of death precedes date of service Verify information (obtain date of death) and correct claims as needed/able.

8. Common “CO” Denials • CO-22 Payment adjusted as this service may be covered by another payer per coordination of benefits Indicates that Medicare is the secondary payer Bill correct primary payer, submit EOB with secondary claim to Medicare (follow Medicare rules whenever Medicare is involved, i.e. primary or secondary payor) If CWF information is incorrect/out-dated, DMEPOS supplier should advise the patient to contact the Coordination of Benefits Contractor (800-999-1118) to have their Medicare Secondary Payer control file updated. After information has been corrected, Supplier can re-submit claim to Medicare.

9. Q & A “Voice” Refill Reminders DME Audit Shield Operations Consulting Argosy Group, Inc Accreditation Preparation DME Billing Service & AR Collector Join us at 10:00 a.m. CST October 14, 2014 for another “Tuesday at Ten” “Avoid KX Modifier Pitfalls”

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11. Reference Sites • www.cms.hhs.gov CMS • www.cms.hhs.gov/manuals/downloads • www.medicarenhic.com (Region A) • www.ngsmedicare.com (Region B) • www.cignagovernmentservices.com (Region C) • www.noridianmedicare.com (Region D) • www.dmepdac.com (Medicare Pricing, Data Analysis and Coding)