Ostomy Supplies Quarterly Results of Targeted Probe and Educate Review - JD DME
Ostomy Supplies Quarterly Results of Targeted Probe and Educate Review
The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A4362, A4362, A4385, A4407, A4409, A4430 and A4432. The quarterly edit effectiveness results from April 2024 - June 2024 are as follows:
Based on dollars, the overall claim potential improper payment rate is 4%.
Top Medical Necessity Denial Reasons
N/A
Top Technical Denial Reasons
- Claim submitted is a duplicate to another claim billed.
- Item was provided prior to an inpatient hospital admission or Part A covered skilled nursing facility stay and its use began during the stay.
Claim submitted is a duplicate to another claim billed.
- Item was provided prior to an inpatient hospital admission or Part A covered skilled nursing facility stay and its use began during the stay.
Educational Resources
Suppliers billing Medicare should be familiar with the documentation requirements and utilization parameters. Visit the Ostomy webpage to access coverage documents (Local Coverage Determination (LCD), Policy Article, National Coverage Determination (NCD)); documentation letters, forms, and checklists; reviews; tips; tools; resources; related articles; and educational events and tutorials, if applicable.
See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3 information about probe/error validation reviews.
