Probe finds 98% error rate for enteral

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Friday, December 14, 2012

WASHINGTON – A prepayment probe by the Jurisdiction D DME MAC found that 98 of 100 reviewed enteral claims were denied because of various primary documentation errors, according to a CMS bulletin. Twenty-four percent of claims were denied because of invalid beneficiary exhaustion, meaning suppliers did not receive refill requests from beneficiaries prior to dispensing. Fourteen percent of claims were denied because they lacked a detailed written order (DWO) either written or reviewed by the ordering physician. Thirteen percent of claims were denied due to lack of documentation, while 11% were denied because a detailed written order was not received by the supplier before the claim was submitted. Based on the high error rate, Noridian Administration Services will close the review and begin a widespread targeted review on enteral claims.