2014 updates from Peggy

US Rehab  newsletter January  2014

2014 updates from Peggy

PECOS edits are on and if the ordering practitioner is not in PECOS you will receive a denial. reference

: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf

This is how the denial will appear:  CO-16 – Claim/service lacks information which is needed for adjudication  —N264 – Missing/incomplete/invalid ordering provider name. —N575 – Mismatch between the submitted ordering/referring provider name and records

Steps to Prevent Unnecessary Denials

  1. Check your NPIs for your physicians – cms.hhs.gov/pecos  
    1. If NPI is incorrect just correct and file a new claim

A.    check spelling make sure it matches PECOS report 

B.    No nicknames/ abbreviations or credentials in name field

C.    If apostrophes/hyphens are  on pecos submit on claim

D.    Last name in that field – first name in correct field

E.    Make sure it is the personal NPI and not a group NPI

2.      If practitioner not on the PECOS they can’t order DME and patient will have to see another physician or that physician must complete the PECOS application

3.     ABNs are not appropriate since this is not a Medical Necessity Denial

Chiropractors are not eligible to order or refer supplies or services for Medicare beneficiaries

Denials and Audits;    Top denial reasons –

Lack of clinical documentation __ How can you educate your referral sources.

Use the DME MAC Dear Physicians letters located on the US Rehab site under Resources than Peggy Walker  You will find the Dear Physician letters and Documentation Check off Sheets.

 Documentation Check off sheets can also be found on  DME MAC C and D by going to  Medical Review and then Documentation Check off Sheets.

Tips to prevent errors and audits:

       Good order intake (VOs get name, date and time of person calling)**IMPORTANT** for order Intake —

        Staff Education (reference tools and help sites available)

        Referral education (training webinars & materials) US Rehab can assist with these

        Keep up with revisions (list serves for all 4 jurisdictions) & US Rehab list serve

        Self Audits are a must (should be done at least monthly) Random claims

        Check off sheets for all items provided

        Legibility (“print name” below signature blocks) ( **most noted technical denial) 

        Files need to stay updated

        Keep contact logs –  WATCH dates – note to whom you spoke and what was said times and dates —

        NO supplier generated forms for physician – no preprinted check off orders /CMNs / LMNs.

        CAREFUL with delivery tickets – all signatures legible –can print name

        Dates on Delivery ticket /customer/staff must be same.

       You can use attestation statements from physicians’  or  signature logs


For assistance contact:

Peggy Walker, RN / Director of Reimbursement Services

US Rehab/VGM   — peggy.walker@usrehab.com  800 401 3643

Ronda.Buhrmester@usrehab.com  888 665 6518

Attend monthly free webinars presented by our team Peggy / Ronda / Elizabeth