Surgical Dressings Targeted Probe and Educate Review Updates: January - March 2019

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A6021, A6212, A6196, and A6197. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 82%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Documentation does not support coverage criteria
  • Detailed Written Order (DWO) is incomplete or missing elements
  • Medical record documentation was not received

For complete detail see, Surgical Dressings Quarterly Results of Targeted Probe and Educate Review

            Last Updated Mon, 28 Oct 2019 16:00:51 +0000