Claims review for diabetic strips, lancets finds 71 percent denial rate

A prepayment review of blood glucose strips and lancets by the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has found a denial rate of 71 percent, the contractor reported last week.

The DME MAC looked at 4,429 claims submitted by 765 suppliers for Home Blood Glucose Monitor Supplies (HCPCS Codes A4253 (blood glucose test or reagent strips for home blood glucose monitor, per 50 strips) and A4259 (lancets, per box of 100). The claims were for service dates from August 2011 through February 2012.

Responses to the Additional Documentation Request (ADR) were not received for 1,516 (34 percent) of claims. For the remaining 2,913 claims, 622 claims were allowed and 2,061 were denied resulting in a claim denial rate of 71 percent.
The primary reasons for denial were: medical documentation issues, incomplete documentation, proof-of-delivery problems and billing issues.