NGS Creates Tips for Same/Similar Equipment Claims

Mobility Management | Original Link

By Laurie Watanabe
In response to DME supplier difficulty with denials involving same or similar equipment, National Government Services (NGS), the Jurisdiction B DME MAC, has created a new supplier tool: a reference chart complete with DME category names and HCPCS codes included in those categories.

“According to our most recent data analysis,” said an NGS bulletin issued last week, “the CO-151 denial continues to be one of the top claim submission errors that suppliers receive.”

That denial states, “Payment adjusted because the payor deems the information submitted does not support this many/frequency of services.”

NGS says, “This ANSI code is used when the patient’s Medicare claim payment history includes claims for services that are the same (meaning same Healthcare Common Procedure Coding System [HCPCS]) or similar (meaning it falls within a range of HCPCS) to what is being billed. In addition to ANSI code CO-151, the remittance advice will also include Remark Codes M3 and M25, which serve as additional clarification to the denial.”

The M3 and M25 remark codes state, “Equipment is the same or similar to equipment already being used.”

Same/similar denials may happen, NGS says, because a supplier submits a claim for an item the beneficiary already rents or owns, and the item is within its standard reasonable useful lifetime of five years.

“If a beneficiary has had any piece of equipment from the same DMEPOS item category within the previous five years, a same or similar denial can be expected,” NGS says.

NGS recommended several ways to avoid same/similar equipment denials, including asking the beneficiary if he or she has purchased or is currently renting same or similar equipment from a different DME supplier; using NGSConnex.com, which contains provider account information; and using the DME MAC’s interactive voice response system.

In addition, NGS has created a Same/Similar Reference Chart that lists DME item categories (such as Power Mobility Devices, Wheelchair Seat Cushions, and Manual Wheelchairs) and all the HCPCS codes that fall within those categories.

Click HERE to view the chart on the NGS Web site.

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