The Jurisdiction A, DME MAC, Medical Review Department is conducting a post-payment service specific review of HCPCS code(s) A6010, A6196 and A6197. The final edit effectiveness results from September 2021 through November 2021 are as follows.

Based on dollars, the overall claim potential improper payment rate is 100% for HCPCS A6010.

Based on dollars, the overall claim potential improper payment rate is 88% for HCPCS A6196.

Based on dollars, the overall claim potential improper payment rate is 100% for HCPCS A6197.

Top Denial Reasons

• Documentation was not received in response to the post-payment notification letter.
• Documentation does not support coverage criteria.
• Detailed Written Order (DWO) was not received.
• No medical record documentation was received. Refer to Medicare Program Integrity Manual 3.2.3.8.

Educational Resources

Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Surgical Dressings 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.