DME MAC A Reviews Nebulizer Claims

HINGHAM, Mass. — A Friday notice from NHIC said the
Jurisdiction A DME MAC will continue with a widespread complex
review following a prepayment review that showed a 52 percent
denial rate for nebulizer (E0570) claims.

According to the notice: “Suppliers are reminded they will
receive an Additional Documentation Request (ADR) letter asking for
specific information to determine if the item billed complies with
the existing reasonable and necessary criteria. Failure to supply
the requested information within 30 days of the date on the letter
may result in claim denial.”