HOW CAN MEDICARE JURISDICTIONS SAME OR SIMILAR DENIALS BE REDUCED?

Whenever the providers have to bill same or similar items to patients, there is a long process they need to go through to conduct same or similar checks. Not just the factor is the time that the DME providers are supposed to manage but also it is expertise that they must be sure of while checking whether or not same or similar item is billed previously. After all, the ultimate motive is to get the claim paid. However, the payment is never guaranteed until and unless the Medicare jurisdiction same or similar checks are conducted the right way.

Why do DME providers get Same or Similar Denials?

There are certain pieces of information that must be perused to determine whether the patient already has or had a particular same or similar equipment or not. It’s a process where the supplier acquires information from the patient as well as Medicare IVR or portal. Failing to come across all the pertinent info, only a partial check may be performed which ultimately may be counted for the denial from the insurance.

What information is required from the patient?

• Patient’s HICN
• Confirm if the patient has HMO or employer insurance
• If the patient currently is having an identical item or had in the past
• When the patient was delivered the item and if the item has been returned
• Where the item will be used by the patient
• Information on CMN or DIF (if required)

What information is required from the Medicare IVR or Portal?

The supplier can check the same or similar on the Noridian Medicare Portal (NMP) or IVR. Though it is time-taken, the supplier can rest assured that the info obtained will be correct. The information that is required at the end of the provider for Medicare to process the research and return the result includes as follows –

• National Provider Identification (NPI)
• Provider Transaction Access Number (PTAN)
• Beneficiary’s Medicare ID
• Beneficiary’s first and last name
• Beneficiary’s date of birth
• HCPCS code

What role does Advance Beneficiary Notice of Noncoverage (ABN) play?

In case, upon conducting Medicare jurisdiction same or similar checks, it is determined that the patient already has identical or similar idem, the supplier must provide Advance Beneficiary Notice of Noncoverage (ABN) for the similar item or any item that he believes can be denied by the insurance.

Switch to pVerify Same or Similar for Faster Online Checks

pVerify is an online solution to check same or similar items billed previously across all 4 Medicare jurisdictions.  The provider can upload a batch of a number of patients and within a short span of time he can obtain and download the excel sheet of processed checks. Without spending long hours on manual checks of similar items billed, he can simply use a search option, type in the request and get back the printable batch reports.

Final Word – By all means, it is necessary that the suppliers go through all the required factors to determine medical necessity before billing the same or similar item to the beneficiary.  However, doing it online saves their time and helps increase the revenue cycle.