1. Working a Medicare “CO” Denial
”Tuesday at 10 “
September 9, 2014
Working a Medicare “CO” Denial
Presented by
Argosy Group, Inc
Tel:

2. Disclaimer
It is the intent of the Argosy Group to provide up to date, accurate information . The information contained in this presentation is for educational purposes only and is not presented as legal advice or with any expressed or implied warranty of accuracy.
Argosy Group encourages you to visit and communicate with your Medicare Regional DMEMAC and your Accreditation Agency often

3. “CO” Denials Contractual Obligation
ANSI denial codes are identified on the remittance advice for each claim line
ANSI codes are used to convey appeals information, claim-specific information, additional explanation for claim-level adjustments
CO = Contractual Obligation
The buck stops with the provider of service(s)
Provider CANNOT just pass charges to private or other payer
Must be corrected, resubmitted, re-opened, appealed or absorbed

4. Common “CO” Denials CO-18 CO -151
Duplicate claim (allow 14 days for electronic claims before re-submitting)
Utilize DMEPAC Claim Status Inquiry
Address the original claim (appeal or resubmit with
necessary) information
CO -151
Payer deems information submitted does not support this level
of service, many services, length of service, dosage, or day’s
supply
Commonly associated with “same/similar”
Review “remark” codes to drill down to specific issue

5. Common “CO” Denials OA-109
Claim not covered by this payer. You must send claim to
correct payer (e.g. Another Medicare jurisdiction, Medicare
Replacement Plan or altogether different primary payor)
Claims are processed based on beneficiaries address on file
with Social Security.
Verify address used on the claim is the same address on file
with SSA
Electronic claims will transfer to correct Jurisdiction; however
provider must have a signed EDI enrollment on file with that
Jurisdiction for the claim to be processed

6. Common “CO” Denials CO-176
Payment denied because prescription is not current
Verify requirements for initial, revised or recertification (CMN)
Check CMN status (those on file) with Medicare to see if another provider may be involved
Ensure all sections of a CMN are completed prior to submitting
Submit CMN with initial claim ONLY
Wait hours before submitting subsequent claims

7. Common “CO” Denials CO-13 Date of death precedes the date of service
Medicare Part B coverage was not valid when the patient received
this item/service
After coverage was terminated
Prior to coverage
Date of death precedes date of service
Verify information (obtain date of death) and correct claims as needed/able.

8. Common “CO” Denials CO-22
Payment adjusted as this service may be covered by another
payer per coordination of benefits
Indicates that Medicare is the secondary payer
Bill correct primary payer, submit EOB with secondary claim to
Medicare (follow Medicare rules whenever Medicare is involved, i.e. primary or secondary payor)
If CWF information is incorrect/out-dated, DMEPOS supplier should advise the patient to contact the Coordination of Benefits Contractor ( ) to have their Medicare Secondary Payer control file updated. After information has been corrected, Supplier can re-submit claim to Medicare.

9. “Avoid KX Modifier Pitfalls”
Q & A
“Voice”
Refill Reminders
DME
Audit
Shield
Operations Consulting
Argosy Group, Inc
Accreditation
Preparation
DME Billing Service &
AR Collector
Join us at 10:00 a.m. CST October 14, for another “Tuesday at Ten”
“Avoid KX Modifier Pitfalls”

10. Let Argosy Group help you navigate your DME business
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Accounts Receivable Recovery and Management
Real-Time On-Line Insurance verification
Independent Chart Audit Programs
On-site or On-line Consulting (Intake to Billing)
Policy & Procedure Manuals Development
Accreditation Readiness & Mock Reviews
On-line Continuing Education (CEUs)
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The Argosy Group, Inc and Raintree RX has given us the confidence to spend more time growing our business and less time on paper-work. It is user friendly and cost-effective. Filing of claims is timely and questions are answered right away. I highly recommend Raintree RX as the new age “Pharmacy & Specialty DME” billing solution Rose Johnson, DME Manager Able Care Pharmacy & Medical Supplies, Enfield CT

11. Reference Sites www.cms.hhs.gov CMS www.cms.hhs.gov/manuals/downloads
(Region A)
(Region B)
(Region C)
(Region D)
(Medicare Pricing, Data Analysis and Coding)