HINGHAM, Mass. — After concluding its most recent widespread prepayment review of claims for power wheelchairs (HCPCS K0823), NHIC, the DME MAC for Jurisdiction A, will continue to review those claims.
In a March 4 post, NHIC said its review involved prepayment complex medical review of 779 claims submitted by 251 suppliers. Responses to the Additional Documentation Request (ADR) were not received for 213 (27 percent) of the claims. Of the 566 claims for which responses were received, 221 claims were allowed and 345 were denied, resulting in a claim denial rate of 61 percent.
The total denied allowance amount (dollar amount of allowable charges for services determined to be billed in error) divided by the total allowance amount of services medically reviewed resulted in an overall Charge Denial Rate of 52.4 percent. Of the denied claims, the DME MAC said 60 percent did not contain the clinical documentation to justify medical necessity.
Read the full post on the NHIC website.
