ASK A QUESTION

Language Suggestion for DMEPOS SBR for MUE Denial

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.

Explanation

From the DWC Website FAQ:

Workers’ Comp DME Codes

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?

Additional Information

DWC FAQ - About durable medical equipment (DME) dispensed by physician

DWC Official Medical Fee Schedule

DaisyBill Resources

Webinar: Request for Second Review

Webinar: SBR Strategy Kit, Part I

Webinar: SBR Strategy Kit, Part II

DaisyBill Solution

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.

REQUEST DEMO

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