K0823 Claims Review to Continue, TriCenturion Says

COLUMBIA, S.C.–On Friday, TriCenturion released the
first-quarter results of its prepayment review of K0823 power
wheelchairs and said the review will continue.

In September, the Jurisdiction A/B DME Program Safeguard
Contractor said a prepayment probe showed sky-high denial rates of
87.51 percent for Jurisdiction A and 93.36 percent for Jurisdiction
B. (See
HomeCare Monday, Sept. 24.)

For the first quarter of the review, the Charge Denial Rate was
89.75 percent for Jurisdiction A and 88.73 percent for Jurisdiction
B, the DME PSC said.

TriCenturion noted the majority of the claims were denied
because policy criteria weren’t met or because no medical records
were submitted for review.

The following were listed as the major reasons for denial:

–The physician order did not have all of the required seven
elements.
–It was not documented that a reason for the physician visit was
for a mobility examination.
–Functional limitations were not addressed in the face-to-face
evaluation.
–Letters of attestation were submitted without supporting
information from the medical record.
–Supplier-created mobility evaluation forms were submitted as a
substitution for information from the medical record.
–There was no date stamp or equivalent to verify supplier receipt
of the physician order within 45 days.

TriCenturion said the prepayment review will continue.