Urological Supplies Targeted Probe and Educate Review Updates: April-June 2019

The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A4351, A4352, and A4353. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 30%.

Top Denial Reasons

  • Documentation does not support coverage criteria
  • Detailed Written Order (DWO) is incomplete or missing elements
  • Refill request documentation is incomplete or missing elements

For complete detail see, Urological Supplies Quarterly Results of Targeted Probe and Educate Review

            Last Updated Tue, 22 Oct 2019 12:58:29 +0000