| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| January 26, 2009 Wide Spread Quarterly Review Results - Glucose Supplies HCPCS A4253, A4258, A4259The Jurisdiction A Medical Review department recently completed a widespread Prepay probe for Glucose Supplies covering HCPCS codes A4253, A4258 and A4259. A widespread pre pay probe is a selection of claims reviewed for medical necessity based on a particular service from multiple suppliers.This review was conducted from August through December 2008. A total of 17,988 claims were reviewed. Of the claims reviewed, 65.14% were denied. The following are the most common reasons for denial:Duplicate denials caused by:Overlapping dates of service by different suppliersOverlapping dates of service by the same suppliersSuppliers changing their dates of serviceSuppliers changing their billing frequencyLCD related denials:Suppliers billing in excess of the usual policy amounts without sufficient information from the medical record to provide justificationMissing or incorrect prescriptionsIt is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the Glucose Monitor LCD and policy article. Suppliers can review the Glucose Monitor LCD on the DME MAC A Web site at: http://www.medicarenhic.com/dme/medical_review/mr_lcd_current.shtml |
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