Positive Airway Pressure (PAP) Devices Targeted Probe and Educate Review Updates: October-December 2018

The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) E0601. The quarterly edit effectiveness results from October 2018 through December 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 15%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Detailed Written Order (DWO) was not received.
  • Documentation does not support coverage criteria.
  • Medical record documentation was not authenticated (handwritten or electronic) by the author.

For complete detail see, Positive Airway Pressure (PAP) Devices Quarterly Results of Targeted Probe and Educate Review

            Last Updated Mon, 04 Mar 2019 10:31:35 +0000