COLUMBIA, S.C.--A fourth-quarter widespread prepay review of negative pressure wound therapy claims turned up charge denial rates of 90 percent in Jurisdiction A and 61 percent in Jurisdiction B, according to TriCenturion, the DME PSC for those regions.
In both instances, the reviews were sparked by high 2006 CDRs for claims using HCPCS E2402, 75.5 percent in Jurisdiction A and 83.72 percent in Jurisdiction B.
Jurisdiction A saw an increase in the fourth quarter CDR from the third quarter CDR of 85.06 percent. TriCenturion said 72 percent of the claims were denied because Medicare policy criteria were not met, and 18 percent were denied for non-response.
In Jurisdiction B, the CDR decreased from 74.58 in the third quarter to 61.01 percent in the fourth quarter. Of those denials, 51 percent of the claims did not meet policy criteria and 17 percent were denied for non-response. Eleven percent of the claims reviewed were reopened, with a third overturned and paid, and two-thirds affirmed as denied.
The DME PSC said its reviews will continue in both regions.
TriCenturion reminded providers that during a widespread review,
any claim billed with the appropriate HCPCS code might be selected
for review.
