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Tag: prepay review


Also Noted

Coming soon: Prepay reviews for tilt and tilt and recline

May 14, 2015HME News Staff

NASHVILLE, Tenn. -The Jurisdiction C DME MAC has announced widespread prepayment reviews for power tilt (E1002) and power tilt and recline (E1007) wheelchairs. If their claims are selected for review, providers will receive a request for additional documentation that must be received within 45 days, or the claims will be denied.

prepay review, tilt, Wheelchairs


Also Noted

Jurisdiction C DME MAC releases results of prepay reviews

March 7, 2014HME News Staff

A claim review of the initial month of therapy for CPAP devices (E0601) for Oct. 1, 2013, to Dec. 31, 2013, showed a denial rate of 48%. In the previous quarter, the rate was 56%. The most common reason for denial: The documentation did not include a copy of a board certified document, screen print from a national certification agency, etc., that verifies that the physician who interpreted the sleep test met policy requirements (30%)…A claim review for oxygen concentrators (E1390) for Oct. 1, 2013,...

denial rate, prepay review


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Also Noted

MAC publishes prepay reviews for support surfaces, glucose monitors

February 13, 2014HME News Staff

INDIANAPOLIS - The claim error rate for Group 2 pressure reducing support surfaces (E0277) was 74% between July 1, 2013, and Sept. 31, 2013, according to a prepay review by National Government Services (NGS), the DME MAC for Jurisdiction B. NGS reviewed 275 claims: 239 were denied and 36 were approved. It found that 21% of claims were denied due to no response to the additional documentation request letter…The claim error rate for glucose test strips (A4253) was 98.5% between Oct. 1, 2013, and Dec....

glucose monitors, NGS, prepay review, support surfaces


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Also Noted

No stop to prepay review for certain power wheelchairs

August 5, 2013HME News Staff

INDIANAPOLIS - National Government Services (NGS), the DME MAC for Jurisdiction B, has reported a claims error rate for power wheelchair bases with options and accessories of 64% between April 1, 2013, and June 30, 2013. NGS examined 754 claims that were developed for additional documentation and it paid in full only 234 claims. The most common reason for denials: The physical and functional findings that were documented in the medical records failed to clearly establish medical necessity for power...

denials, error rate, power wheelchairs, prepay review


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Editorial

New rule also impacts prepay review process

December 28, 2012Guest Commentary

Most of the guidelines for prepayment medical review are found in manual guidance issued by CMS. However, the agency did issue a regulation in 2008 requiring contractors to terminate the prepayment medical review of a provider no later than one year following the initiation of the review or when calculation of the error rate indicates the provider reduced its initial error rate by 70% or more. The regulation further required contractors to conduct, at a minimum, quarterly evaluations.  On Nov....

prepay review


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News

In brief: Face-to-face rule, IR meeting, PWC prepay review

July 10, 2012HME News Staff

BALTIMORE - CMS issued a proposed rule this week that details its plans to require a face-to-face evaluation within 90 days of a written order for certain high-cost durable medical equipment.The rule gives four criteria that would subject items to the requirement:1.)    items that currently require a written order prior to delivery;2.)    items that cost more than $1,000;3.)    items that we, based on our experience and recommendations from the DME MACs,...

face-to-face requirement, inherent reasonableness, Lincare, linde, prepay review


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