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