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 3.2.3.8.
  • 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