Following our recent webinar on "Preventing the Top 5 HME Denials," we received numerous questions from attendees about specific denial scenarios. Andrea Stark from Miravista and Joey Graham from Prochant reconvened to answer them in a dedicated follow-up session. Here are some of the key questions and expert insights shared:
- Handling PECOS Denials: Question: When dealing with a PECOS denial due to the doctor no longer being certified, can I obtain an updated order signed by a different certified doctor after the denied date of service?
Answer: If the patient has seen another certified doctor, obtaining a new order signed by the new doctor is advisable. However, oftentimes, the issue may be administrative on the doctor's side, requiring communication and coordination with their office to resolve effectively.
- MAP Process for New Enrollees: Question: What recourse is available after the initial 90-day window under the recently changed MAP process for new enrollees with active service?
Answer: Beyond the initial 90 days, MAP regulations can enforce prior authorization and network standards. This window serves to ensure the continuation of care and minimize coverage gaps in reimbursement, emphasizing timely compliance with regulatory requirements.
- Timely Filing and Doctor Coordination: Question: How can we ensure timely filing to avoid denials related to delayed submission of information from doctors?
Answer: Proactively initiating the documentation process early and communicating timelines clearly to doctors can significantly mitigate the risk of timely filing denials. Early action on your part allows doctors ample time to provide the necessary information, fostering smoother claims processing.
- Managing Denial Activity: Question: Is high denial activity problematic with Medicare?
Answer: While Medicare monitors denial rates as part of supplier activity, high denial rates alone do not necessarily indicate fraud or abuse. It is essential to manage claim volumes effectively and respond promptly to any development letters from Medicare to ensure compliance and continued reimbursement.
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Have more questions or need further assistance with HME billing and denial management? Contact Prochant today for expert guidance and support tailored to your specific needs.