Urological Supplies Quarterly Results of Targeted Probe and Educate Review - JD DME
Urological Supplies Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A4351, A4352 and A4353. The quarterly edit effectiveness results from July 2024 - September 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 27%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not support permanent urinary incontinence or permanent urinary retention.
- Medical record documentation does not demonstrate the medical necessity for use of a Coude tip catheter.
- Medical record documentation does not support the quantity billed. Refer to Medicare Program Integrity Manual 100-08, Chapter 5, Section 5.9.
Top Technical Denial Reasons
- Date of service for item(s) billed has been partially paid. Refer to CMS Manual Pub 100-02 Chapter 15, Section 50.5.1-50.6 & 110-140.
- Beneficiary does not reside in this jurisdiction.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Urological Supplies 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.
