Positive Airway Pressure (PAP) Devices Targeted Probe and Educate Review Updates: January - March 2018

The Jurisdiction D, DME MAC, Medical Review Department is conducting a targeted probe and educate review of HCPCS code E0601.

Based on dollars, the overall claim potential improper payment rate is 7%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • The time limit for filing a claim expired.
  • The documentation does not include a written order prior to delivery for the item(s) specified in the Affordable Care Act 6407. Refer to Social Security Act 1834(a)(11)(B)(i).
  • The supplier indicates the item(s) were billed in error. Refer to SDL A55426.

For complete details, see the Positive Airway Pressure (PAP) Devices Quarterly Results of Targeted Probe and Educate Review webpage

Last Updated Jun 07, 2018