Enteral Nutrition Targeted Probe and Educate Review Updates: October - December 2018

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) B4150, B4152 and B4154. The quarterly edit effectiveness results from October – December 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 60%.

Top Denial Reasons

  • Refill request documentation is incomplete or missing elements.
  • Medical record documentation was not authenticated (handwritten or electronic) by the author.
  • Documentation does not support coverage criteria.
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.

For complete detail see, Enteral Nutrition Quarterly Results of Targeted Probe and Educate Review.

Last Updated Mar 05, 2019