Diabetes claims miss required documentation

Friday, October 31, 2008

NASHVILLE, Tenn.--Diabetes providers in Jurisdiction B have a 91% denial rate for blood glucose test strips, according to the results of a post-pay probe, said Cigna Government Services in September. Of 137 claims reviewed, 125 were denied because documentation was submitted without claim; documentation did not support frequency of testing; and claims did not have a valid physician order prior to date of service. Claims were also denied for utilization errors, including billing in excess of standard guidelines and ordering one item and billing for another. Providers can review the glucose monitor local coverage determination at www.nsgmedicare.com.

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