National Government Services (NGS), the Jurisdiction B DME MAC, reported in a Feb. 27 bulletin that it examined 257 claims for intermittent catheterization kits in the last quarter of 2012 as part of its ongoing widespread prepayment medical review.
The HCPCS code for the affected claims was A4353.
NGS said it denied 220 claims for an 85.6-percent claim error rate. Of the claims, 61 were turned down because suppliers did not submit the requested additional documentation within the required timeframe.
The most common reason for denial in quarter four was “failure to meet one or more of the required coverage criteria,” NGS said. Other denials were issued because of invalid refill requests, insufficient or missing proof of delivery, insufficient medical records and insufficient detailed written orders.
