Article Detail - JA DME
Knee Orthoses Targeted Probe and Educate Review Updates: July - September 2018
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 July - September 2018 are as follows:
Based on dollars, the overall claim potential improper payment rate is 79%.
Top Denial Reasons
- Documentation does not support coverage criteria
- Documentation was not received in response to the Additional Documentation Request (ADR) letter
- Documentation does not support custom fit criteria
- Advance Beneficiary Notice of Noncoverage (ABN) was not properly executed
For complete detail see, Knee Quarterly Results of Targeted Probe and Educate Review.
Last Updated Mon, 31 Dec 2018 13:35:32 +0000