Surgical Dressings 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) A6021, A6212, A6196 and A6197. The quarterly edit effectiveness results from October – December 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 77%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Documentation does not support coverage criteria.
  • Documentation received does not support medical necessity for the item requested.
  • Refill request documentation is incomplete or missing elements.

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

            Last Updated Tue, 05 Mar 2019 10:28:56 +0000