Medicare denials

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    I am the Mds coordinator/ADON at at nursing home in Texas, and we are receiving Medicare denials to pay like crazy, my question is why? Is It a billing error, we provide the documentation requested but why are we getting them in the first place! Please help! The denials are very frustrating and time consuming!
    Thanks!
    Amy
  2. 4 Comments so far...

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    You might want to post this in the MDS section and ask Talino for an answer...no one smarter about all things MDS and Medicare.
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    I was a MDS coordinator here in Texas at the beginning of last year. After January 1, 2013, the number of pnd denials on MCD and ADR's on MCR shot through the roof. I also would be interested to know why that happened. I failed to find any info on it and never received anything from DADS or CMS to explain the sudden scrutiny on claims. It does take an exuberant amount of time to get those claims approved. Please let us know what you find out. Thanks.
  5. 0
    Ok thanks!
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    You don't mention the explanation given for the denials, which is odd- but then again, the denials may have little to do with the MDS, per se, and if your place isn't integrated (as in a multi-disciplinary PPS team), the people responsible for the denials may, for whatever reason, not share that with the MDS Coordinator- but that would be even odder, considering the financial hit the place must be taking? Did your place just open? Is there a revolving door of staff in many departments? Do you have a home office- if yes, I would think they'd have been parked in the lobby, by now, asking questions.


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