Review finds 63% error rate for CPAP devices

Thursday, June 26, 2014

FARGO, N.D. – A pre-payment review by Noridian found potential improper payment rates of 63% for CPAP devices from February to May 2014. The Jurisdiction D DME MAC reviewed 2,873 claims with the KH modifier (first month of billing) and 1,663 claims with the KJ modifier (4th-13th month of billing). It found most denials were due to invalid proof of delivery; no documentation in response to the additional documentation request letter; documentation submitted did not demonstrate that face-to-face clinical re-evaluation criterion were met for continued coverage beyond the first three months for KJ claims; and documentation submitted did not support that face-to-face criterion was met. Noridian says it will continue its prepayment service specific review.