Medicare Appeal, DME

[somarco]

I wonder if its a normal thing to not have the CPT code on the medical necessity form?

Can't say . . . the PCP's office might know . . . the person who coordinates and files claims, not the one who greets patients in the waiting room.

If the practice is "large" they will probably have a MOM (medical office manager), but most offices bundle the days claims and transfer them to an offsite claim manager. If the practice is owned by a hospital, they are the ones responsible for filing.

But initial coding should happen in the PCP office.

Have you seen the form? Is there a place for a CPT code, or HCPS code?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865623/

 

[ValeRosso]

Can't say . . . the PCP's office might know . . . the person who coordinates and files claims, not the one who greets patients in the waiting room.

If the practice is "large" they will probably have a MOM (medical office manager), but most offices bundle the days claims and transfer them to an offsite claim manager. If the practice is owned by a hospital, they are the ones responsible for filing.

But initial coding should happen in the PCP office.

Have you seen the form? Is there a place for a CPT code, or HCPS code?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865623/

I have seen the form, there is no designated place for a CPT or HCPS code. It’s from a hospital network in her area. It states:

Medical Necessity Certificate
Prescription Date: xxx
Diagnosis: xxx
ICD10 Code: xxx
Prognosis: Good
Rx: Wheelchair with leg attachments due to non weight bearing status. Discharged from hospital unable to bear any weight.
Physicians Name, address, signature

Xxx are filled in by the Dr but didn’t want to put the entire page up.

I’ll be in her area tomorrow so Ill help her get the appeal filled out and keep my fingers crossed it wont have to go any further. Thanks for the link, it was a good read.

 

[somarco]

https://www.medicare.gov/basics/forms-publications-mailings/forms/appeals

https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal

 

[ValeRosso]

Thanks for those links and the help. The 1st appeal has been filed, we’ll see what happens.