[flamingo909]

hi, i have several patients switching from medicare hmo to medicare, billing for oxygen(cmn attached). when i bill, i get claims denied even though i'm adding a note stating they changed from hmo to medicare. any tips, suggestions how to avoid denials and get paid?

[Sleeping410]

What's the denial code?

[flamingo909]

hi, here are denial reasons:


16 Claim/service lacks information which is needed for adjudication.
Additional information is supplied using remittance advice remarks
codes whenever appropriate
A04 Secondary payment cannot be considered without the identity of or
payment information from the primary payer. The information was
either not reported or was illegible. not sure about the secondary denial reason?? thanks

[ddembia]

We have had good luck with patients switching back to Medicare from a Medicare HMO. Medicare requires a new initial CMN with the first claim, however new testing is not required for that CMN. We use the narrative to state that the patient is switching to Medicare from an HMO.

[dchavez]

Hi there,

medicare may still have the beneficiary as hmo in their data base, u want to research all the way around instead of re-sending and getting denials. Look into your juristicion guidelines and find out if you are using correct modifiers,and codes. Also if you still aint sure,call medicare and they will help you,with tips.

Hope this helps..

[Sleeping410]

With a CO-16 I think your problem is not getting a new Initial when the patient returns to Medicare from the HMO. Otherwise it would be OA-109. Sounds like an easy fix.