MEDICARE DENIALS

By Amanda Kissinger, Billing Services Group Manager

Medicare denials are perplexing. And frustrating. One small detail missed—and a service won’t be covered. Particularly frustrating are Medicare denials for glasses after cataract surgery—even though you are credentialed with Medicare.

What’s going on?

Here Are Some Helpful Tips To Keep In Mind To Ensure You Don’t Have To Deal With Medicare Denials For Glasses:

• Glasses after cataract surgery are considered medically necessary by Medicare, but they can’t be processed by traditional Medicare, thus leading to Medicare denials for glasses.
• Medicare will pay for one pair of post-cataract surgery glasses per lifetime per eye after cataract surgery.
• You must be credentialed with the Durable Medical Equipment Department, which will process the claim.
• Call the Durable Medical Equipment Department to ensure there are no stipulations that would limit the patient’s access to glasses. Each case is unique. And there are stipulations to be aware of.
• For instance, if a beneficiary has a cataract extraction with IOL insertion in one eye, and then has a cataract extraction with IOL insertion in the other eye, and does not receive eyeglasses or contact lenses between the two surgical procedures, Medicare covers only one pair of eyeglasses or contact lenses after the second surgery.
• There are other stipulations to familiarize yourself with.
• When you submit the claim, you will use a specific PTAN for your DME Medicare, which is different than your traditional Medicare.