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Politics : Formerly About Advanced Micro Devices -- Ignore unavailable to you. Want to Upgrade?

To: J_F_Shepard who wrote (579182)	8/2/2010 8:31:26 PM
From: Brumar89	Respond to of 1588268

Yes, Breitbart's article was based on the AMA's report card! Check page 5: ama-assn.org The fact is Medicare has a higher denial rate than every other insurer measured in the report. The only insurer that comes close to Medicare's denial rate was Aetna and their primary denial was this: "Payment adjusted because the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated." IOW the benefit was included in the payment/allowance for some other procedure and the denial prevented a duplicate payment/allocation. Medicare's top denial reason was: "Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code)." Sounds like a coding issue. Only 1% of Aetna's denials was due to that. Medicare's #2 reason for denial was: "These are non-covered services because this is not deemed a ‘medical necessity’ by the payer." IOW Medicare doesn't agree with the health provider that the service was necessary. Hope they're right. If not ..... Funny, I couldn't find that reason given for ANY of the private insurers. Hmm. Maybe Medicare has a tougher definition of what is medically necessary.