Article Detail - JD DME
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