The DME MAC Jurisdiction A has completed a widespread prepayment review of claims for continuous airway pressure devices (HCPCS E0601). These findings include claims processed from April 2012 through June 2012.
The review involved prepayment complex medical review of 855 claims submitted by 295 suppliers. Responses to the Additional Documentation Request (ADR) were not received for 244 (28%) of the claims. Of the 611 claims for which responses were received, 279 claims were allowed and 332 were denied/partially denied. This resulted in a claim denial rate of 54%. The total denied allowance amount (dollar amount of allowable charges for services determined to be billed in error) divided by the total allowance amount of services medically reviewed resulted in an overall Charge Denial Rate of 50.9%.
Based on the results of this prepayment review, DME MAC A will continue to review claims billed for continuous airway pressure devices.