Rough Review for Blood Glucose Monitors in Jurisdiction A

HINGHAM, Mass. — The results of a prepayment review of claims for home blood glucose monitor supplies in Jurisdiction A weren’t exactly stellar, according to the DME MAC.

Initiated because of a high volume of claims errors identified by the CERT contractor, NHIC reviewed documentation compliance for 995 claims with dates of service from November 2010 through January 2011. Out of that number, only 31 claims were approved. For 701 — or 70 percent — of the claims, NHIC said, responses to the Additional Documentation Request were not received.

For the 249 claims for which ADR responses were received, 218 (87.5 percent) were denied, mainly because: 63 percent of the claims were missing the supplier record of the refill request; 48 percent were missing documentation that the beneficiary or caregiver had completed training or was scheduled to begin training in the use of the monitor, test strips and lancing devices; 26 percent had incomplete detailed written orders and 19 percent were missing the detailed written order; and 23 percent were missing proof of delivery.

NHIC reminded providers “that repeated failure to respond to ADR requests could result in a referral to the Jurisdiction A Program Safeguard Contractor/Zone Program Integrity Contractor.”