Glucose Monitors (HCPCS A4253) Quarterly Edit Effectiveness Results of Service Specific Post-Payment Review - JA DME
Glucose Monitors (HCPCS A4253) Quarterly Edit Effectiveness Results of Service Specific Post-Payment Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a post-payment service specific review of HCPCS code(s) A4253. The quarterly edit effectiveness results from May 2021 through July 2021 are as follows.
Based on dollars, the overall claim potential improper payment rate is 88% for HCPCS A4253.
Top Denial Reasons
- Documentation was not received in response to the post-payment notification letter.
- No medical record documentation was received. Refer to Medicare Program Integrity Manual 220.127.116.11.
- Documentation does not support medical necessity.
- Documentation does not support usual utilization for an insulin-treated diabetic.
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Glucose Monitors webpage to access coverage documents.
- National Coverage Determination (NCD)
- Local Coverage Determination (LCD)
- Policy Article
- Documentation letters, forms, and checklists
- Review tips, tools, and resources
- Related articles
- Educational events and tutorials, if applicable
See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 for more information on medical record reviews.
Last Updated Wed, 15 Sep 2021 14:16:39 +0000