Denials for K0823s from Jurisdiction A are UP

Denials for K0823s from Jurisdiction A are UP

2012 2nd quarter was 62.3% 3rd was 77.4% 4th was80.6% First quarter 2013 – 86.6%

Let’s break this down –

15% denials were for no response – why would anyone not respond to an additional documentation request? Maybe they were just billing for a denial to go to a secondary?

(a) All suppliers should respond to these with a note stating this was just being billed for a denial for secondary so there is a response there.

228 claims received there were only 25 allowed – /Why did they deny?

  1. 1. 50%were denied due to clinical documentation.
  • 1 (a) basically most of these are just the fact that the information is subjective instead of objective and the supplier has to educate their staff on how to distinguish between objective and subjective data and MAKE sure that the first sentence states the patient is in an evaluation for mobility. If it does not meet criteria then do an ABN or do non assigned which will still require an ABN.
  • We need to watch the signatures and dates – they have to be legible and any signature must have a date behind it/ beside it. This is something we can catch up front.
  • Signatures of physicians concurring with therapy exam missing – we can have this corrected before we send in the claim / and of course the OLD DATE STAMP WHEN RECEIVED – go get a stamp and stamp all incoming mail when received and you won’t miss it.
  • The majority of these errors we can control by having a check off sheet and making sure staff use it.
  1. 7element order issues –AGAIN check the dates and signatures on these – make sure they are complete – date stamped – not on same form or dated same as the DPD and EVERYTHING MUST BE LEGIBLE.
  2. DPDS– Did not received a DPD / incomplete DPDs/ Date stamp when received / must be dated prior to delivery but after the 7 element order/ must have detailed description (name/ model of base and all accessories) No signature or illegible signature and even DPD was illegible
  3. Delivery tickets – did not receive a copy of a delivery ticket/ did not match claim date/ no beneficiary signatures or date/ Delivery ticket did not match the DPD.
  4. No attestation statement of no financial relationship with supplier.
  5. Home Assessment issues – done prior to F2F – not done at all- not signed/dated

SUPPLIERS MUST BE MORE DILIGENT IN REVIEWING PAPER WORK BEFORE BILLING A CLAIM.

US Rehab has a pmd check off sheet for you to use –  and it is listed as pmd audit checklist.

Peggy Walker RN, Director of Reimbursement Services 800-401-3643