Article Detail - JA DME
Ankle-Foot Orthosis (AFO) Top Denials
Noridian's Medical Review Department just released the second quarter Targeted Probe and Educate review results. The top AFO denial reasons apply to suppliers across the board. It’s good to know what to do to avoid these denials. Here they are:
Top Medical Necessity Denial Reasons
- Medical record documentation does not support the beneficiary requires stabilization for medical reasons.
- Medical record documentation does not support the beneficiary is ambulatory.
- Medical record documentation does not support the beneficiary has the potential to benefit functionally.
Top Technical Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter.
- Claim is the same or similar to another claim on file.
- Documentation does not include verification that the equipment was lost, stolen or irreparably damaged in a specific incident.