Urological Supplies Targeted Probe and Educate Review Updates: April - June 2018
The Jurisdiction D, DME MAC, Medical Review Department is conducting a targeted probe and educate reviews of HCPCS code(s) A4351, A4353 and A4358. The quarterly edit effectiveness results from April 2018 - June 2018 are as follows:
- Based on dollars, the overall claim potential improper payment rate is 40%.
Top Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter.
- Documentation does not support coverage criteria.
- Claim is billed for greater quantity than the Detailed Written Order (DWO) indicates.
- Detailed Written Order (DWO) was not received.
For complete detail see, Urological Supplies Quarterly Results of Targeted Probe and Educate Review.
Last Updated Aug 13, 2018