INDIANAPOLIS — In a Thursday update, National Government Services, the Jurisdiction B DME MAC, said it is continuing a widespread prepayment medical review for K0823 power chairs. During the first quarter of 2011, NGS' medical review department examined 63 claims that had been developed for additional documentation. Of these, 44 were denied — a 70 percent claim error rate. According to the update, the top issues causing the denials were not responding to the ADR letter within the required 30-day timeframe, and "no medical records submitted, or the medical records submitted did not establish medical necessity."
Earlier this month, the DME MAC said it would begin a widespread prepayment medical review of random claims for CPAP devices (E0601KJ). Suppliers of the selected claims will be sent a documentation request letter must return the requested documentation within 30 days from the date of the letter or the claim will be denied as not medically necessary.
