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Reimbursement Page By Devon Bernard, AOPA government affairs department
The Rules for Proper Completion of Medicare Orders Avoid claim denials and high error rates with this review of current policies
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veryone is aware of the Medicare prepayment reviews taking place throughout all the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) jurisdictions, and most everyone is aware that Medicare is reporting high error rates on all these pre-payment reviews. Some of the causes for these high error rates—such as physician documentation—are beyond the control of the facility providing care. But some of the reasons for the error rates, three in particular, are within the control of the facility. For example, the results of a recent Jurisdiction D DME MAC prepayment review for spinal orthoses L0631 and L0637 indicated that 26 percent of claims denied—contributing to an almost 83 percent error rate—were because people didn’t respond to the request for information. This means that the facility did not send in any information to support the provision of the L0631 or L0637. So, if you receive an additional documentation request from any entity, be sure to respond; failure to respond will result in an automatic denial. O&P providers also can control error rates by completing a valid proof of delivery for every item they provide. In the last Jurisdiction A DME MAC prepayment review for lower-limb prostheses, 15 percent of the denied claims were due to providers not providing a proof of delivery or providing an incomplete proof of delivery. These recent results showed a 62 percent overall error rate—the lowest to date and a 28 percent decline since the reviews began in 2012. If this overall rate dropped by an additional 15 percent, the rate might have been low enough to end the prepayment reviews for lower-limb prostheses.
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O&P Almanac SEPTEMBER 2013
Finally, providers can control error rates by producing proper, valid, and complete orders/ prescriptions. For example, the first results of the Jurisdiction D DME MAC prepayment review for AFOs L4360, L1970, and L1960 indicated that 54 percent of all the denials were due to missing or invalid orders/prescriptions. It’s clear that we all could benefit from a review of the rules regarding Medicare orders.
Determining Eligibility Before we discuss what constitutes valid orders for Medicare, let’s quickly review who, other than doctors, is eligible to sign prescriptions/orders for O&P services and items under the Medicare program. Nurse practitioners may write and sign Medicare orders for O&P items and services as long as they