MAC publishes prepay reviews for support surfaces, glucose monitors

Thursday, February 13, 2014

INDIANAPOLIS – The claim error rate for Group 2 pressure reducing support surfaces (E0277) was 74% between July 1, 2013, and Sept. 31, 2013, according to a prepay review by National Government Services (NGS), the DME MAC for Jurisdiction B. NGS reviewed 275 claims: 239 were denied and 36 were approved. It found that 21% of claims were denied due to no response to the additional documentation request letter…The claim error rate for glucose test strips (A4253) was 98.5% between Oct. 1, 2013, and Dec. 31, 2013, according to another prepay review by NGS. During that time, NGS developed 7,952 claims for additional documentation: 7,831 were denied. It found that 60% of claims were denied due to lack of medical necessity.