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PalmettoGBA lists the following five items as their top
reasons for a denial:
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“Noncovered services” – these services are never
covered, including eye refraction, “well person” exams, and hot/cold
packs used in physical therapy.
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Bundling due to “Correct Coding Initiative “ –services
denied most often for these reasons include: pulse oximetry; heparin;
creatinine (blood); and some supplies
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Medicare is secondary, but the claim was submitted as
primary. The MSP Lookup Tool can help guide you as to whether another
insurer may be involved.
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Noncovered services by a chiropractor – the only service
Medicare will reimburse, when performed by a chiropractor, is manual
manipulation of the spine (CPT codes 98940, 98941, and 98942). Physical
therapy and x-rays performed by chiropractors are never covered by
Medicare.
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Pre- and post-op visits are included in the global
surgery package. Tip: access the CMS Medicare Physician Fee Schedule
Database (MPFSDB) to determine the global period for surgical
procedures. The Palmetto GBA Modifier Lookup tool provides step-by-step
instructions for accessing the MPFSDB as well as guidance on how to
submit “exceptions” to the global surgery package.
Use the Denial Finder to determine whether your denials for
these services are correct or whether there are other steps you should take
before submitting these claims - look in the “Cool Tools” section on the
site below: Ohio:
http://www.PalmettoGBA.com/boh
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