NHIC Corp., the Medicare Jurisdiction A DME MAC, has released results of its 2012 second-quarter widespread prepayment review for K0823 claims.
The review involved 514 claims by 188 suppliers for Group 2 standard power chairs with captain’s seating and weight capacities up to 300 lbs.
NHIC requested additional documentation for all the claims, but did not receive it for 5 percent of the claims. NHIC did receive additional documentation for the rest of the claims and allowed 26 percent of them. NHIC denied 74 percent of the claims based on the documentation supplied.
The overall charge denial rate for the quarter was 62.3 percent. The charge denial rate for the first quarter of 2012 was 54.7 percent.
NHIC said 56 percent of denied claims showed insufficient documentation, including “reasonable and necessary issues,” such as documentation from the mobility exam failing to include a comprehensive face-to-face exam conducted by the physician and addressing mobility limitations to “provide a clear picture of the patient’s mobility deficits.”
Thirty percent of denied claims had problems with the seven-element order, including one or more of the elements being missing. Eighteen percent of denied claims had problems with the required detailed product description (DPD), such as the DPD being dated before the seven-element order or dated after the power wheelchair had been delivered.
Delivery ticket problems were seen on 9 percent of all denied claims.
NHIC added that some denied claims had more than one missing or incomplete item.
“Based on the results of this prepayment review,” NHIC said in its news announcement, “DME MAC A will continue to review claims billed with HCPCS K0823.”
