90% Error Rate on K0823 Claims — Forms Won’t Work, Noridian Says
A Jurisdiction D DME MAC prepayment review of K0823 power wheelchairs has resulted in a 90% error rate, mostly because of lack of documentation, according to a Noridian Administrative Services notice.
FARGO, N.D. — A Jurisdiction D DME MAC prepayment review of K0823 power wheelchairs has resulted in a 90 percent error rate, mostly because of lack of documentation, according to a March 24 notice from Noridian Administrative Services.
Of the 648 claims reviewed by the DME MAC, 576 were denied, with top reasons including failure to respond to a request for records, insufficient medical records and no valid written order. According to the notice, some claims included no face-to-face exam or missing elements of the exam.
“Many suppliers have created forms which have not been approved by CMS which they send to physicians and ask them to complete,” the DME MAC said. “Even if the physician completes this type of form and puts it in his/her chart, this supplier-generated form is not a substitute for the comprehensive medical record.”
Read the notice in full.
Last month, Cigna Government Services, the DME MAC for Jurisdiction C, said it would be implementing a service-specific prepayment edit for K0823 PWCs as the result of data “demonstrating a high claims payment error rate for this power wheelchair product category.”
Read the full notice.
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