K0005: Reasons for Medicare Denials
RemitDATA provided the following Medicare funding statistics for ultralightweight manual chairs, HCPCS code K0005, from Dec. 16, 2013, through March 24, 2014.
Data used for analysis: Electronic remittance advice (ANSI 835), service line detail. Unexpected denial rate: 18 percent Top reasons for unexpected denials according to RemitDATA:
- OA18: Other Adjustment — Duplicate claim/service.
- CO16: Contract Obligation — Claim service lacks information needed for adjudication.
- CO4: Contract Obligation — The procedure code is inconsistent with the modifier used or a required modifier is missing.
- CO15: Contract Obligation — The authorization number is missing, invalid, or does not apply to the billed services or provider.
- CO29: Contract Obligation — Time limit for filing is expired.
This article originally appeared in the May 2014 issue of Mobility Management.