National Government Services (NGS), the Jurisdiction B DME MAC, says it will continue its widespread prepayment reviews of Group 2 standard power chairs following a 77-percent denial rate for claims examined in quarter two.
The prepayment review involved HCPCS code K0823 – power chairs with captain’s-style seating and a patient weight capacity up to and including 300 lbs. For quarter two, NGS reviewed 115 K0823 claims and denied 88 of them.
NGS said in a bulletin issued last week that a third of claims reviewed were denied because of failure of suppliers to provide additional documentation for the claims, as requested.
Another 28 percent of claims were denied because “no valid medical records were found in the supplier’s response, or the medical records received did not establish medical necessity.”
