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Knee Orthoses Targeted Probe and Educate Review Updates: April-June 2019
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) L1832, L1833, L1843, and L1851. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:
Based on dollars, the overall claim potential improper payment rate is 62%.
Top Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter
- Documentation does not support coverage criteria
- Advance Beneficiary Notice of Noncoverage (ABN) was not properly executed
- Documentation does not support custom fit criteria
For complete detail see, Knee Orthoses Quarterly Results of Targeted Probe and Educate Review
Last Updated Tue, 22 Oct 2019 12:51:11 +0000