Positive Airway Pressure (PAP) 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) E0601. The quarterly edit effectiveness results from July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 16%.

Top Denial Reasons

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

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

            Last Updated Thu, 20 Dec 2018 16:43:47 +0000