COLUMBIA, S.C.--TriCenturion announced on Thursday that it has completed a widespread prepayment review of foam dressings billed with the A1 modifier that showed close to a 100 percent denial rate for the claims in both Jurisdictions A and B.

The probe was initiated as a result of data analysis that identified "a significant number" of beneficiaries who received excessive dressings compared to the LCD allowable number of services, the DME PSC said.

The denial rate for HCPCS A6209-A6214 was 99.25 percent for Region A and 98.77 percent for Region B. In Jurisdiction A, 71 percent of the claims were denied as not medically necessary, and 28 percent were denied for no response. In Jurisdiction B, 65 percent were denied as not medically necessary with 34 percent denied for no response.

According to results of the probe, some denials resulted from missing physician orders and lack of documentation for frequency of change, the amount and size of the dressing and duration of need. TriCenturion said other information lacking in medical records showed that:

--Wound measurements were not documented;
--The amount of drainage documented did not support the need for the dressing;
--Wound depth measurement did not indicate full thickness involvement;
--Supplier-created forms were submitted as a substitution for the medical record; and
--Monthly wound measurements were not submitted.

To view the probe results in full, click here.