[Regina]

We are in region A and in the past few months have had 3 same and similar denials for people who had no same and similar on file with the IVR. When we call region A, the patient had the equipment seven or eight years ago, and the claim has to go to review. On review they ask for prescription, doctor's notes, copy of the ABN, etc. These are usually commodes or walkers. Is this happening in any other regions? What's the point of the IVR if we get denials anyway?!

[HEATHER]

Each region's IVR/VRU only references that particular region's database when
you check same and similar equipment. They do not refer to the Common
Working File (CWF) which has info for all regions. If the patient's address
with Social Security was in a different region in the past 5 years, you have
to check that region's IVR/VRU too. We ask at intake if the patient has had
an address outside the state within the past 5 years. We have a lot of
snowbirds.

[Regina]

I know the CWF was checked on two of these patients.

[Kristin]

This article was recently published by my Jurisdiction about the IVR same/similar option, it states it is supposed to pull from CWF and local Jurisdiction records.

https://www.noridianmedicare.com/dme...r_option5.html

One thing I found out today that might be a good tip for future reference, when checking a procedure code for same or similar, there is an option to add a modifier but if you don't know it you can say "no modifier". Well if you decide to state "no modifier" it won't pull accurate information. I checked one today with no modifier and it said there is no SS equipment, then I checked again with NU modifer and with RR modifier added, and it found same/similar equipment on file.

[Regina]

We do not have the option to check with a modifier in region A.

[LEANN ANDERSON]

I thought I was the only provider going crazy with the s&s denials. I call the IVR, nothing on file. I call customer service nothing on file, then they check the common working file and it pulls something from 9 or 10 years back. Even the customer service people at Medicare are telling me that this is not supposed to flag a s&s denial!! Off to review it all goes. What a waste of time and money.
Why doesn't the president just announce that Medicare will no longer pay for equipment instead of making it harder and harder to get paid less and less money?

[serina.breen@comcast.net]

LeAnn,

What items specifically are you getting denials for same/similar on? I have
not had this experience.

Best Regards,
Serina Breen
Freedom Mobility Center
586 Parker Ave - Rodeo, CA 94572
Tel 510.799.9920
Fax 510.280.0778
Serina.Breen@comcast.net

[Regina]

I agree LeAnn. We have had this happen several times- commodes, walkers, and a hospital bed.
It is amazing how much time and money Medicare is willing to waste.