DME MAC A Continues Review of K0823

HINGHAM, Mass. — NHIC said Friday the Jurisdiction A DME
MAC will continue to review K0823 power wheelchair claims based on
the results of previous pre-payment probe findings. In the fourth
quarter of 2009, results showed a 72.1 percent denial rate.

In a recently concluded review for the first quarter of 2010,
results showed a 45.7 percent denial rate, with incomplete
documentation (67.3 percent) the main reason for denial.
Documentation for the some of the claims reviewed had incomplete
prescriptions, no face-to-face exam, no mobility evaluation and no
home assessment. More than 30 percent of the claims were determined
to be not medically necessary.

To justify the discontinuation of a pre-payment audit, the DME
MAC said the charge denial rate must show a reduction of 70 percent
or more from the previous quarterly findings.