Review finds 85.6% error rate for intermittent caths

Thursday, February 28, 2013

WASHINGTON – A prepayment review of intermittent catheterization kits processed in Jurisdiction B resulted in an 85.6% error rate, according to National Government Services (NGS), the DME MAC there. Of 257 claims processed from Sept. 1–Dec. 31, 2012, 220 were denied, according to the review. The most frequent denial—“failure to meet one or more of the required coverage criteria”—accounted for 37% of denied claims. Sixty-one of the claims were denied because the requested documentation was not returned within the required timeframe. Additional reasons for denials include: invalid refill requests; proof of delivery was insufficient or missing; medical records were insufficient; and detailed written orders were insufficient.