HINGHAM, Mass. — NHIC announced Friday that it will continue its widespread prepayment review of K0823 power wheelchair claims in Jurisdiction A. Its most recent quarterly review, which resulted in an overall charge denial rate of 52 percent, involved 768 claims with dates of service from January through March submitted by 225 suppliers.
Results showed responses to the Additional Documentation Request were not received for 135 (17 percent) of the claims. Of the 633 claims for which responses were received, 297 claims were allowed and 336 were denied, due mainly to insufficient documentation to support medical necessity.
In its first K0823 review covering claims in the second quarter of 2010, the overall CDR was 75.3 percent.
"NHIC appreciates the hard work by suppliers that has resulted in the improvements in the error rate over the past year," the DME MAC said about the recent review. "We encourage all suppliers to continue to examine their K0823 claims for compliance with all of the LCD requirements."
