Urological Supplies Prepayment Review to Continue in Jurisdiction B

• By Laurie Watanabe
• Nov 15, 2011

National Government Services (NGS) will continue its prepayment review of Medicare claims for intermittent sterile catheter kits following the reporting of its third-quarter results.

For the third quarter of 2011, NGS reviewed 166 claims for the catheter kits – HCPCS code A4353 – and denied 149 of them, for a claim error rate of 89.8 percent.

NGS, the Jurisdiction B DME MAC, said the two most common reasons for denying claims was a failure of providers to supply additional documentation as required (which accounted for 48 percent of denials) and failure to establish a beneficiary’s medical justification for the kits (which accounted for 40 percent of denials).

In many cases, NGS added, the beneficiary’s medical records did not “adequately reflect the need for the level of care provided.”