Positive Airway Pressure (PAP) Devices Quarterly Results of Targeted Probe and Educate Review - JA DME
Positive Airway Pressure (PAP) Devices Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0601. The quarterly edit effectiveness results from January 2024 - March 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 10%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not contain a clinical evaluation by the treating practitioner prior to the sleep test.
- Medical record documentation does not contain a sleep test.
- Medical record documentation does not contain a clinical evaluation by the treating practitioner.
Top Technical Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter.
- Medical record documentation is not authenticated (handwritten or electronic) by the author.
- Face-to-face encounter is not authenticated (handwritten or electronic) by the author.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the PAP webpage to access coverage documents (Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD)); documentation letters, forms, and checklists; reviews; tips; tools; resources; related articles; and educational events and tutorials, if applicable.
See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.
