Claims Error Rate for NGS PMD Prepayment Review Drops Sharply

The 2014 fourth-quarter claims error rate for Medicare power mobility device (PMD) claims reviewed by National Government Services dropped sharply, the Jurisdiction B DME MAC has reported.

In a March 4 news announcement, National Government Service (NGS) reported the error rate for the review period of Oct. 1 through Dec. 31, 2014, was 56.2 percent.

In comparison, the claims error rates for the NGS widespread prepayment review for quarter 3 was 81 percent. The second-quarter claims error rate was 84 percent, and the rate for the first quarter was 87.7 percent.

There was also a sharp drop in the number of claims NGS reviewed in the fourth quarter.

NGS reported reviewing just 89 claims, of which 39 were allowed and 50 were denied.

In comparison, the DME MAC reviewed 1,071 claims in the third quarter.

The Centers for Medicare & Medicaid Services (CMS) expanded its PMD prior authorization demonstration project on Oct. 1, 2014. At that time, 12 more states -- including the Jurisdiction B states of Indiana, Kentucky and Ohio -- joined the seven original states in the demonstration.

That means five of the seven NGS states -- Illinois, Indiana, Kentucky, Michigan and Ohio -- are now part of the PMD demonstration project.

For the fourth-quarter PMD claims denied, NGS said the most common reasons for refusal included failure to prove that the Medicare beneficiary did not have the upper-extremity function to self propel an optimally configured manual wheelchair, and date stamps or the equivalent to prove supplier receipt of the detailed product description were missing.

Despite the significant improvement in claims error rates in quarter 4, NGS indicated it “continues to conduct a prepayment medical review of [power wheelchairs with] HCPCS [codes] K0820-K0829.”

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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