Surgical Dressings (HCPCS A6196, A6197 and A6010) Quarterly Edit Effectiveness Results of Service Specific Post-Payment Review - JA DME
Surgical Dressings (HCPCS A6196, A6197 and A6010) 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) A6010, A6196 and A6197. The quarterly edit effectiveness results from June 2021 through August 2021 are as follows.
Based on dollars, the overall claim potential improper payment rate is 76% for HCPCS A6010.
Based on dollars, the overall claim potential improper payment rate is 72% for HCPCS A6196.
Based on dollars, the overall claim potential improper payment rate is 93% for HCPCS A6197.
Top Denial Reasons
- Documentation was not received in response to the post-payment notification letter.
- Documentation does not support coverage criteria.
- No medical record documentation was received. Refer to Medicare Program Integrity Manual 3.2.3.8.
- Detailed Written Order (DWO) was not received.
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.