Urological Supplies Quarterly Results of Targeted Probe and Educate Review - JA DME
Urological Supplies Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A4349, A4351, A4352, A4353 and A4358. The quarterly edit effectiveness results from April 2024 – June 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 2%.
Top Medical Necessity Denial Reasons
- Medical record documentation does not support permanent urinary incontinence or permanent urinary retention.
Top Technical Denial Reasons
- Claim is billed for greater quantity than the order indicates. Refer to Medicare Program Integrity Manual 5.9 and applicable Local Coverage Determination/Policy Article.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Urological Supplies webpage to access coverage documents (Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD)); documentation letters, forms, and checklists; reviews; tips; tools; resources; related articles; and educational events and tutorials, if applicable.
See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.
