Tag: DME MAC Jurisdiction B

WASHINGTON - A prepayment review of power wheelchair claims processed in Jurisdiction B resulted in an 80% error rate, according to National Government Services (NSG), the DME MAC there. Of 1,022 claims processed from Oct. 1 2012­-Dec. 31, 2012, 122 were paid in full, while the remaining claims were completely or partially denied, according to the review. The most common reasons for denials were: Local Coverage Determination (LCD) criteria not met; face-to-face examination with a physician not established;...

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...