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CGS Medical Review Quarterly Reports by Policy

Analysis of claim denials for knee orthoses HCPCS codes L1833 and L1851 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 65.52%. Please click here for the top 10 reasons for claim denials.

Analysis of claim denials for AFO HCPCS codes L1902, L1906, L1971, L4396, and L4397 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 30.79%. Please click here for the top 10 reasons for claim denials.

Analysis of claim denials for lumbar sacral orthosis (LSO)HCPCS codes L0457, L0637, L0648, and L0650 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 38.37%. Please click here for the top 10 reasons for claim denials.

Analysis of claim denials for therapeutic shoes/inserts for diabetic persons HCPCS codes A5500 and A5512-A5514 reviewed between April 1, 2021 and June 30, 2021 revealed a denial rate of 88.35%Please click here for the top 10 reasons for claim denials.

 

Please click the links below for additional policy information.

Medicare Announces Rule to Protect Consumers from Surprise Medical Bills

Announcement is the first in a series of regulations aimed at shielding patients from increased financial hardships stemming from surprise medical bills

The Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.

Please click on these links for more information   Consumer Protection  / What you need to know

No Healthcare organization can afford to waste money, time, or personnel on outdated systems.

No healthcare organization can afford to waste money, time, or personnel on outdated systems. In this issue of Becker’s Health CareReview, learn how our MotionMD®, VeriPro®, and OaraScore® software solutions can help improve efficiency, security, and benefit the industry in an interview with EVP of Healthcare Solutions Steve Ingel.  Please click here to read the entire article.  Becker’s Healthcare Article

The New Reality of Patient-as-Payer

In theory, health care consumerism is a straight-forward idea: Shifting costs to consumers, typically in the form of high-deductible health plans (HDHPs), gives them an incentive to make informed decisions about the health care services they purchase. In practice, consumerism represents a significant challenge to providers’ bottom lines. A recent report reveals that for 74% of providers, patient collections take over a month. Further, 66% of providers said patient receivables are a primary revenue concern.  Please click on this link to view the entire article. Health Care Consumerism.