December 2019 Client Newsletter
OXFORD ISSUING NEW MEMBER ID CARDS WITH A NEW ID #
Oxford is issuing new member ID cards with a new 11-digit policy #. Be sure to request a copy whenever Oxford patients are seen and forward a copy to us.
FINAL REMINDER - NEW MEDICARE CARD CMS DEADLINE JANUARY 1st
Just a reminder that effective January 1, 2020 Medicare will cease paying claims without the patient's new Medicare number. Be sure to REQUIRE patients to provide it - if not, consider not seeing the patient after January 1st & rescheduling the patient until the new card is provided.
The cards have been sent for almost 2 years. We also strongly advise that when as patient calls for an appointment, verify that you have the new #. If not, remind them it is required to be seen.
For our clients who check eligibility on the Medicare website, or who use the Healthpac Eligibility verification feature, Medicare requires the new # to do this also.
If a patient says they did not receive their card, they need to contact Medicare (800-MEDICARE) to obtain it. There have been MANY reminders sent by CMS to all Medicare patients.
AFO/KAFO Targeted Review - L1970, L4360, L4361
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) L1970, L4360, and L4361. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:
Based on dollars, the overall claim potential improper payment rate is 34%.
Top Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter
- Documentation does not include verification that the equipment was lost, stolen or irreparably damaged in a specific incident
- Claim is the same or similar to another claim on file
- Detailed Written Order (DWO) is incomplete or missing elements
For complete detail see, Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) Quarterly Results of Targeted Probe and Educate Review
Therapeutic Shoes Targeted Probe and Educate Review Updates: April-June 2019
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A5500. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:
Based on dollars, the overall claim potential improper payment rate is 49%.
Top Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter
- Claim is a duplicate to a previously submitted claim
- Detailed Written Order (DWO) is incomplete or missing elements
- No medical record documentation was received
For complete detail see, Therapeutic Shoes Quarterly Results of Targeted Probe and Educate Review