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| PR-16 Claim Denials Supplies and Accessories Used with Beneficiary-Owned Equipment The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) recently published an article addressing documentation requirements for supplies used with beneficiary owned equipment. The article only addressed equipment that was not paid for by MedicareFee-for-Service (i.e., only equipment that was paid for by other insurance or by the beneficiary). For supplies and accessories used with beneficiary owned equipment that was not paid for by Medicare Fee-for-Service, all of the following information must be submitted with the initial claim in Item 19 on the CMS-1500 claim form for paper claim submitters or in the NTE segment for electronic claim submitters: · HCPCS code of base equipment; and,· A notation that the equipment is beneficiary owned; and,· Date the patient obtained the equipment. Example: E0601 Beneficiary Owned 01/01/2006 Claims for supplies and accessories must include all three pieces of information listed above. Claims lacking any one of the above elements will be denied with ANSI code PR-16 with a remittance remark code of M124, which indicates the charge is denied because it is missing an indication of whether the patient owns the equipment that requires the part or supply. In the past, the only course of action suppliers had to correct these issues was to go through the appeals process. However, on Friday, May 8, 2009 a change was made to the Medicare claims processing system which will now allow suppliers the opportunity to simply resubmit these claims for payment with the additional information in Item 19 or the NTE segment. Suppliers can receive payment quicker if they refile these claims. If you have previously submitted a claim that received this denial to redeterminations and would rather resubmit the claim you may do so, as opposed to waiting for a redetermination decision. If you choose to refile your claim(s), National Government Services will simply dismiss your request for redetermination. |
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