From van Halem Group: Avoiding Same or Similar Claim Denials

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Same or similar denials occur when claims information is checked against the patient’s CMN history. This will indicate when equipment is “same or similar” to that piece of equipment being billed on the claim. 

These types of denials can be avoided early on when providing DME equipment to patients. The essential step in preventing this type of denial is by having a thorough intake process. Suppliers are encouraged to use an intake form to assure all necessary information is obtained prior to dispensing DME items. Such information may include: 

  • Patient’s correct Medicare Beneficiary Identifier (MBI); 
  • Whether the patient has other insurance 
  • Patient’s current and previous address to check against MAC Jurisdictions/states 
  • If the patient currently has or had this type of equipment or similar equipment in the past; 
  • When the item(s) were received and if the item(s) have been returned; 

It is the supplier’s responsibility to check the Supplier Interactive Voice Response (IVR) system or portal to determine if same or similar HCPCS are on file for a patient within the previous five years or specific reasonable useful lifetime (RUL) for an item. 

To read the full article from van Halem Group, click here


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