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Apr 26th, 2018 - alleegator13

Medicare Services Denied

WE just received a statement from Medicare demanding their money back because a patient was in a Skilled Nursing Facility at the time of service. I looked up the charges and it was for receiving Diabetic Shoes (DME)- codes A5500 and A5512) . I asked the other coders here and looked at the dictation for the past visits and nothing states she was at a facility, or that she had moved. My boss wants me to re-bill but it sounds like Medicare thinks the SNF should pay for it. I cant find anything on the CMS/Medicare websites that help us at all. Should I set it to patient responsibility or re-bill with new modifiers/facility codes?

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