Review finds 85.6% error rate for intermittent caths
By HME News Staff
Updated Thu February 28, 2013
WASHINGTON - A prepayment review of intermittent catheterization kits processed in Jurisdiction B resulted in an 85.6% error rate, according to National Government Services (NGS), the DME MAC there. Of 257 claims processed from Sept. 1-Dec. 31, 2012, 220 were denied, according to the review. The most frequent denial—“failure to meet one or more of the required coverage criteria”—accounted for 37% of denied claims. Sixty-one of the claims were denied because the requested documentation was not returned within the required timeframe. Additional reasons for denials include: invalid refill requests; proof of delivery was insufficient or missing; medical records were insufficient; and detailed written orders were insufficient.
Comments