[blyons]

We received a denial today for a redetermination request......stating the ABN was not signed by the beneficiary (pts wife signed). The Medicare DME MAC A Supplier Manual states "Signed by the beneficiary or his or her representative" as one of the ABN requirement's on p74.
When we called Medicare we were told that if the pt does not sign, the person who signs for them has to be on record AT MEDICARE as their REPRESENTATIVE. We futher asked if we have copy of a POA or proxy on file, would that be sufficient...and we were told NO.....the person has to be on file and write REPRESENTATIVE after their LEGIBLE signature.
What is everyone's requirements when they get an ABN?????
THANKS!!!!
Barbara

[HEATHER]

We provided an E0181 (alternating pressure pad w/ pump) to a client who already received an E0185 (gel pad overlay) within the past 5 years. The ABN said it would likely be denied for similar equipment. The patient sent it for review, we forgot to include the GA mod on the claim, their review was denied but said pt responsibility was $0. So we sent a redetermination request w/ copy of ABN (signed by patient) asking that they add the GA mod to the claim and show patient responsibility 100%. They denied our request stating that because we didn't supply any medical records that it didn't show the patient met coverage criteria - not an issue of similar equipment - therefore we were responsible. My original denial had the M3 (similar equp) code. This is all so ridiculous. Makes me furious. Why would I get medical records for a lesser item when I know it will be denied for similar equipment? If the POA papers are good in a court of law it should be good enuf for Medicare. It isn't just some random person signing for them...

[DMEisgoodfun]

I'd be curious to know if Medicare would inform you who the rep is that they
have on file. If they wouldn't, it seems that would help you in your appeal.
I'm sure an ALJ would agree that we can't reasonably be expected to follow
that guideline (which I hadn't heard of before) if Medicare won't share with
us who the rep on file is. Medicare has all the power to deny and
arbitrarily claim "that's not who we have on file."