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Linda Collins Blogger

Four for Backs

Posted by Linda Collins | February 05, 2014

Jurisdiction D, Noridian, has announced the latest results for its Spinal Orthoses prepayment review (codes L0631 and L0637). Denial rates were in the range of 83%-87%. The reasons for denial of payment are almost equally divided amongst four errors:

  • Failure to meet coverage criteria listed in the LCD for Spinal Orthoses
  • Invalid proof of delivery
  • No coding verification as required by PDAC for the delivered item
  • Failure to respond to requests for additional documentation

Noridian stated that due to the high error rate, the prepayment review for these codes would continue.

What does this mean for you?

  • Utilize Össur’s Spinal Orthoses Claims Checklist created by Össur to assist you in determining the coverage criteria  Spinal Orthoses Claims Checklist
  • Review the methods of delivery and required proof of delivery documentation outlined in the Program Integrity Manual, 4.26,58.
  • Check the PDAC website to verify the product you are using is valid for code L0631 or L0637.
  • Respond within the stated timeframe when you do get a request for additional documentation.

Four basic steps to cover your back and move away from prepayment denials.

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