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PTCA MEDICARE DENIAL RATE INCONSISTENCIES CITED

This article was originally published in The Gray Sheet

Executive Summary

PTCA MEDICARE DENIAL RATE INCONSISTENCIES CITED as an example of an overall pattern of variability in insurance carriers' decisions to reject claims for lack of medical necessity, General Accounting Office Assistant Comptroller General Eleanor Chelimsky told the House Small Business/Regulation Subcommittee March 29. Looking at denial rates for percutaneous transluminal coronary angioplasty at six private insurance carriers that process Medicare claims, GAO found that "one carrier had a denial rate of 182 [per 1,000 claims allowed], two had denial rates of about 30, while three carriers did not deny any services for medical necessity."
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