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Aug 9th, 2014 - Jatin 3 

DME Denial from Medicare

Hello,

We have received a denial from Medicare for DME claims stating that ordering physician is not registered with PECOS. Our doctor is occupational therapist in Northern CA and we are submitting claims with her as ordering occupational therapist. We have received payment in 2013, but from 2014 we are getting denials.

Please can anyone guide me on this ASAP.

Thanks,

Jatin

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Aug 9th, 2014 - jvosfernea 66 

re: DME Denial from Medicare

there are two professionals mentioned in your entry - both an OT and an 'ordering physician'; it is unlikely that both are the same person. Even an OT that also has an MD would need to write the script as an MD, not the OT.
I'm not familiar specifically with northern CA, so maybe there is something there w/which I'm not connecting? Federally, an OT can identify the DME that is approp for the Pt (say, has fitted a wheelchair to the Pt), may quite likely be instrumental in 'ordering' that W/c from the vendor, . . . and in most cases will still need a written script from a full MD servicing the case to turn the script into MDCD/MDCR/etc.
Tho' maybe I'm not fully understanding your situation?

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Aug 10th, 2014 - Jatin 3 

re: DME Denial from Medicare

Hello,

My question is that we received a denial from Medicare for DME stating that ordering physician is not registered with PECOS. We have been keeping ordering physician as the name of our OT only. We don't have any MD. Our OT is the one who is prescribing the DME for the patients.

Please advise me.

Thanks,

Jatin

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Aug 18th, 2014 - LBAROGIANIS 250 

re: DME Denial from Medicare

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareOrderingandReferring.html

This article will tell you the new changes that was implemented on 04/07/14. You can always search on www.CMS.Gov for any information you need.

Hope this helps.

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