Surgical Dressings Targeted Probe and Educate Review Updates: July - September 2018

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 July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 69%.

Top Denial Reasons

  • Documentation does not support coverage criteria
  • Documentation was not received in response to the Additional Documentation Request (ADR) letter

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


            Last Updated Mon, 31 Dec 2018 11:59:20 +0000