As a physician, you hate it when your patients are denied coverage for supplies that they need. This is especially true when it is something affecting their quality of life, such as ostomy supplies. Therefore, you need to make sure you do your part to reduce denied claims. Here are a few guidelines to help you reduce denials for your patients’ ostomy equipment.
Before the supplier submits a claim for the supplies, you need to have communicated with your patients’ insurance companies. Make sure you do this step promptly to reduce the potential for a denied claim. If the supplier submits the claim before you have initiated communication, they will deny it as unjustified.
2. Justify the Need
For your patients to get ostomy supplies coverage, you will need to justify the need when you first submit the order. Once you can establish a need during this first order, this will automatically justify any following orders. As long as your patient needs this device, they will receive it without repeating this step.
3. Correct Coding
To ensure no claims are denied, submit the items under the correct coding information. To complete this task, check with your chargemaster to ensure you are sending the proper code through the system. This will greatly reduce the number of claims denied by physician error, which can leave you feeling guilty and your patients feeling frustrated.
4. Proof of Delivery
Most insurance companies require that you maintain proof of delivery documents for each patient receiving ostomy supplies. Therefore, you should make this documentation available whenever it is asked for.
You want to ensure that insurance covers your patients’ ostomy supplies. Following these guidelines will help you accomplish that mission. Be sure to take all of these steps to get the least amount of denied claims.