Have you submitted your October claims to their MAC already?  Have you received any denials for medical necessity due to medical diagnoses?  Well if you haven’t, you just might.

Hospitals reported in October, after submitting their claims to their MAC, they received denials for uncovered services.  Palmetto, Cahaba, and Novitas are a few MACs who have reported issue with their ICD-10-CM code edits and incorrect LCDs.  The MACs report that providers are receiving incorrect denials for medical necessity and claim rejections and have instructed providers not to do anything with these incorrectly denied/rejected claims as they will correct the ICD-10-CM code edits and automatically fix the claims.  Whew!  That’s comforting, isn’t it?

Well, I am reluctant to say that it isn’t so comforting to me.  I guess I am the kind of person whose glass is half empty.  Most SNF claims haven’t been submitted yet and all I can imagine is an influx of claim rejections and denials due to incorrect LCDs.

If you receive claim rejections or denials from your MAC for services that were previously covered under the LCD with ICD-9-CM, please contact your MAC and inform them of these claim rejections/denials.  The reasons your claim isn’t getting paid is not what it’s “quacked” up to be!

Gina Tomcsik

Director of Compliance