Thank you Caralyn for keeping us informed.Our social worker,who acts as contact person
for our managed care contracts,is having a fit about these denial letters.As the PPS
MDS I do the regular MED A letters.Managed care companies that we deal with,interpret
the skilled rules differently than I do.The casemanager for the company that we deal
with the most,insists that the DR or RNP delete any orders to take an a.p.rate before
admin. of Dig.She says the taking of the rate is considered skilled.She and I have
gone around on several issues.This company,apparently is worried that the QIO may find
in favor of the bene should they request an expediated appeal.This company has hired a
special person to review all these records before the QIO comes in.I don't interpret
the reg that way.I thought the medicare+ company was suppose to give the bene a more
complete explanation about the denial should they request an appeal and were to get
info for the QIO.
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