tci Medicare Compliance & Reimbursement - 2009 Issue 19

COMPLIANCE: Watch Date-of-Service on Osteoporosis Claims

Avoid denials with this official guidance. If you're getting denied for osteoporosis drug injections, you aren't alone -- and the Centers for Medicare & Medicaid Services has taken note.Problem: Many claims submitted for covered osteoporosis drugs don't provide a date of service that falls within the start and end dates of an existing prospective payment system (PPS) episode, according to a recent MLN Matters article. Medicare outlines three criteria for covering injectable osteoporosis claims: • Patients are eligible for home health services; • Physicians certify that the individual sustained a bone fracture related to post-menopausal osteoporosis; and &bull...

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