Error rate hits 95% for diabetic shoes
WASHINGTON – Ninety-five percent of claims for therapeutic shoes for persons with diabetes were denied in the third quarter of 2012, according to a prepayment review conducted by National Government Services, the DME MAC for Jurisdiction B. Of 258 claims reviewed, 246 were denied. Twenty-two percent were denied because requested documentation was not returned, while 63% were denied as not medically necessary. Some of the top issues contributing to the denials, according to the review, were lack of responses for additional documentation requests (ADR) within the required timeframe, lack of documentation from physician qualifying the foot condition, and lack of proof of delivery. Providers can review the requirements for therapeutic shoes on the National Government Services web site.