Generally, when submitting a workers' comp SBR for incorrectly denied payment, the SBR must include a specific reason that additional reimbursement is due.
Frequently Asked Question
Q: Do you have any language suggestions for a DMEPOS SBR for MUE denial?
A: When a claims administrator incorrectly denies a DMEPOS bill based on the practitioner services MUE, we suggest that you assert something like this when completing the SBR:
“A medically necessary piece of DME may not be denied based on the Practitioner Services MUE. DME is NOT a part of the physicians fee schedule and thus MUE edits do not apply. Please reprocess this line item.”
This will provide the required substantive reason for filing an SBR under the above circumstances.
From the DWC Website FAQ:
From DaisyBill, here's an example of the suggested language using our SBR Generator:
For more on MUEs in the context of DMEPOS, read Do NCCI Edits (such as MUEs) apply to the DMEPOS fee schedule?
Webinar: Request for Second Review
Webinar: SBR Strategy Kit, Part I
Webinar: SBR Strategy Kit, Part II
DaisyBill’s billing software integrates easy Second Bill Review submission seamlessly into our billing process. For more information about California’s workers’ comp electronic billing, book a demo and see how DaisyBill solves workers' comp billing problems.