Article Detail - JA DME
Nebulizer Targeted Probe and Educate Review Updates: April - June 2018
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) J7605, J7626 and J7682. The quarterly edit effectiveness results from April 2018 through June 2018 are as follows:
- Based on dollars, the overall claim potential improper payment rate is 18%.
Top Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter.
- Refill request documentation is incomplete or missing elements.
- No medical record documentation was received. Refer to CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 22.214.171.124.
- Documentation does not support coverage criteria.
For complete detail see, Nebulizer Quarterly Results of Targeted Probe and Educate Review.
Last Updated Mon, 10 Sep 2018 14:32:14 +0000